P - 83684� REQUEST FOR ELECTRICAL INSPECTION
f I IIIIII IIIII IIIII�IIII IIIII IIIIIIIIII IIIIIIIII IIII 1^g2leUni essty A earRmf S1e 28CSt. Paul, MN 55104 � ���.
* 0 3 6 3 9 8 4 6* 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 Inspection Fee - This Inspection Request will not be accepted without ihe 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 �j b
Sign/Outline Ltg. Xfmr. 15. �.�
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Ro�9n-o-, Date
}( Speciallnspe �op- 0 te
Final >
Irnestigative � —l.S'
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.
363-984 ��
� � �38�
�`��� JOB NUMBER �l9706000 I
PLEASE PRINT OR TYPE
RequesNfJay21'� � Cj �' Rough-in inspection required? ❑ Yes ❑}�lo Inspection Other Than Rough-In: [X Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 7� 17 � Cj'�
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
00187 LONGFELLOW ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
KAREN M WOLTERS 717-0547
Power Supplier Address
NSP ltPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,IHC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAVAGE KN. 55378
Authorize�ignatuye (Contracto� or OwnerPerf9rtninp Installation) Phone No.
c///sU'/✓lii.v ' �V V V 4� .:. 7'g 1 T"! ! 1 L/�710 �
A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY