P - 83682i REGIUEST FOR ELECTRICAL INSPECTION �'�;�,
� II�II��IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 1ng21eUnivessty A earRmf SI 128cSt. Paul, MN 55104 �.; �'
* 0 3 6 3 2 3 8 7* 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 emp. Service
, "X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspecfion Fee - This Inspection Requesi will not be accepied 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 ,. 0
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boom
Special Inspection . i�
Investigative Fee ;; �
THIS INSTALLATION ti
363-238�]
PLEASE PRINT OR TYPE
iS.
I hereby certify that I inspected the electrical installation described herein on the dates stated
Rough-In Date
�inal � �C' I �e� ' �C..
ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
-� �g �
«�S� �`� � JOB HU?lBER �9706000
Rough-in inspection required? ❑ Yes �lo Inspection Other Than Rough-In: [� Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: %� 17 � 9%
I, �] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) Cit Zip Code
00159 LOGAN PKY NE F�tIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
HERB W JR BACON 571-7806
Power Supplier Address
NSP KPLS OFFICE
Electrical Contractor (Company Name) Contractor License No.
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAVAGE liN. 55378
Au ri d i ature ( trector or O er Performing Installatio� �� ^. ��
�
941-
:B-OOOOtA-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
� Master Lic. No. (Plant Elect. Only) � �