P - 84074( I�iI�I IIIII IIIII IIIII IIIII IIIII IIII) IIIII IIII IIII M$ n� UE a SsatOe BoaLR of SR 1C$cStN aPEMN ION04 � �����.
'* Q 3 7 1 6 4 1 2* Phone (612) 642-0800 �`��"'�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
;alculate Inspection Fee - This In$uection Request will not be accepted without the correcf 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. 1S. 5m
Alarm/Remote Control
Swimming Poo I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Speciallnspection •
Final l / _ ,C1
Investigative Fee �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.
371-641 ?[� �, j5�
,� 6�95
JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Reque�t� 17 � 9`� Rough-in inspection required? ❑ Yes [�{Jo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: S 0I 1% I9%
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
01437 MEADOWMOOR DR NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
SANDRA K GUMNINK 780-8791
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lia No. (Plant Elect. Only)
MASTER ELECTRIC CO. IHC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
1246'7 BOONE AVE S. SAVAGE MN. 55378
Authoyl'�Q'6ig�ture (Contractor or Owner Performing Installation) Phone No.
8/95 STATE BOARD COPY -$E�'fN9�RUCTIONS ON BACK OF YELLOW COPY