P - 84071II�IIII IIIII IIIII IIII) IIIII IIIII IIIII IIIII IIIIIIII Rg �j UEiSersFORve.LRm. SR!C8, StNPaPEMN'5O5N04 � ���,��`
Minnesota State Board of Electricity �'
* Q 3 7 1 6 8 2 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 ihe 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 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 TOTA� �� 50
Sign/Outiine Ltg. Xfmr.
Alarm/Remote Control
Swimmin� Pool :� I:' I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Speciallnspection � Final D �`°
Investigative Fee -e` - - � � r%�
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.
371-682 � `�o
�����5 JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Requ t e Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: .1 0I 1% I 9%
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�o��d���treet, Box, oy Fjp�{�eplo� DR NE ��IDLEY Z�p�5432
LYNli
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupani Phone No.
ROBERT E PROIS 645-9419
Power Supplier Address
NSP MPLS OF'FICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,IMC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAVAGE MN. 55378
Authori�qd�Sigryature (Contractor or Owner Performing Installation) Phone No.
EB-0000
STATE BOARD COPY - SEE
ON BACK OF YELLOW COPY