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REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity � `�
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 �"°�' ��
Other: New Addn
Commercial Industrial Farm rtemo
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enier remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection 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 ONLV TOTAL
Sign/Outline Ltg. Xfmr. 15. 'rJ0
Alarm/Remote Control
Swimming P ,� !� I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Special Inspection Date
Final 6 _ �
Investigative Fee -e'-- �2- "
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
371-677 � � � I�O
� ���
JOB NUMBER �9706000
PLEASE PRINT OR TYPE
Reque�t�aje17 �[j�] Rough-in inspection required? ❑ Yes [�JO Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready:
I, }� licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
07380 JACKSON ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
GERALa L
Power Supplier
OLSOH
Address
ANOKA
Phone No.
786-0334
Electrical Contractor (Company Name) Contractor License No.
MASTER ELECTRIC CO. INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S.SAVAGE MN 55 78
Auth ' S� ature (Contractor or Owner Performing Installation)
h �
EB-00001A- 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
Master Lic. No. (Plant Elect. Only)
Phone No.