P - 83616,�IIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 1^82�1 U�niversry Ae.LRm. SR1C8,cSt PaPEMNION04 ����_
* 0 3 9 2 4 2 0 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 Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'� SWITCH INSTALLAT30H
Calculate Inspection Fee - This Inspection Request will not be accepted without the coirect 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. � . 50
Alarm/Remote Gontrol
Swimming Po i hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom aou�,-in Date
X Speciallnspection 1 . 50 ,
Final
Investigative Fee — — Z� �
THIS INSTALLATION MAY BE ORDERED DIS ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFICE USE ONIY This request vad 18 rtarths fran vaHdation date print in this box.
392-420� ,� �
�
JOB TIUMBER #9$06000
PLEASE PRINT OR TYPE
Request fJa� � 0� 98 Rough-in inspection required? ❑ Yes ❑�o Inspection Other Than Rough-In: [K Ready Now ❑ Wiil Call
11
(You must call the inspector when ready) Date Ready: 1 1/ 3m / 9g
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address iStreet, Box, or Route No.) City Zip Code
06520 LLIGIA LN HE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. Counry
ANOKA
Occupant PFane No.
DAWN M ZIMMERMAN 571-7866
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (PIaM Elect. Ony)
MASTER ELECTRIC Ci3. � IHC. CA01192
Mailing Address (Contractor or Owner Perfaming Installation)
12467 BOOIdE AVE S. SAYAGE MN. SS378
Authorized Signature �ntractor or Owner Performing Installation) Phone No.
V rv � — �
EB-0OOO1A-11 S/95 STATE BOARD COPY - E STRUCTIONS ON BACK OF YELLOW COPY