P - 83681�, I(I�II�IIII IIIII IIII) IIIII IIIII IIIII III'I IIII IIII
*03638673*
REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity ��� �'
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 ihe work covered by this request. Enter remarks in this space and on the back ot the white cqoy 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 ONLY TOTAL �+
Sign/Outline Ltg. Xfmr. 15. 0�'
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
IIrrigation Boom Rough-In Date
I Speciallnspecti
Final D�� � �/
Investigative F ' (/
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. ���,
� 363-867� � �� O i ,,
I ���� JOH NUtIBER �9706000 I
PLEASE PRINT OR TYPE
Request Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call �
I(You must call the inspector when ready) Date Ready %� 1%� 9% �'.
I, u licensed contractor ❑ owner hereby request inspection of the above electrical work at:
� J�051S8�0reet, Box, oiIHCbLH ST NE F�IDLEY Z�P55421
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
JACK R LISOWSKI 571-8331
Power Supplier Address �
NSP MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MA9TER ELECTRIC C0. INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S SAVAGE MN. 55378
Authori ignat re ontractor r ner Perf ��� Phone No.
Y
E-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY