P - 83615I�II� I�I� IIIII (IIII IIIII (IIII (I�II IIIII IIII IIII
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REQUEST FOR ELECTRICAL INSPECTION ���;�,
Minnesota State Board of Electricity ��� °i
1821 University Ave., Rm. S-128, St. Paul, MN 55104 ,,,�
Phone (612) 642-0800 ���"�'�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by ihis request Enter remarks in this space and on the back of ihe white copy only.
SAVER'S SWiTCH IHSTALLATIOH
Calcu/ate Inspection Fee - This lnspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee � Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA��• 50
Sign/Outline Ltg. Xfmr.
Alarm/Remot t
Swimming Po I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Speciallnspection •
Flnal Da �
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MBNTHS.
OFFICE USE ONLY Tha request wid 18 monihs from validation date printed in this box.
392-417�] �5; �
�d6
JOB NUMBER #9$06000
PLEASE PRINT OR TYPE
Requ Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: Re�ly Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 11 / 30 / 98
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�o�r�s�1,.S�{reet, Box, oc��r�,1t,ON ST NE ��2I DLEY zp�432
Section No. Township Name or No. Range No. Fire No. ��� ANOKA
Occupant Phone No.
DAVID I WUDINICH 785-2023
Power Supplier Address
HSP MPLS OFFICE
Electrical Contrac[or (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAVAGE MH. 55378
Au[horized Signature (Contractor or Owner Perfaming �^ PFane No.
� 941 4712/89�-3555
EB-OOOOtA-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY