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'*03869286*
REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity �� `"
1821 University Ave., Rm. S-12S, St. Paul, MN 55104
Phone (612) 642-0800 �"�'-�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on the back of the whrte copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted without the correci 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. 1 � • ��
Alarm/Remote Control
Swimming Pool G } �'' I hereby certify that I ins
pected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In oate
pecial Inspection 1 S. 0
mal D�
fnvestigative Fee !�+ �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request vdd 18 months from validation date printed in this box.
386-928 � /� ;
5� �
JOB NUMBER #970600
PLEASE PRINT OR TYPE
Request Daig ���4 � gg Rough-in inspection required? Q Yes ❑ No}{ Inspection Other Than Rough-In: � f�ady NoW � Will Call
(You must call the inspector when ready) Date Ready: 8� 14I9S
I, ❑ mcensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, w Route No.) City Zip Code
0?385 MEMORY LN TIE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant � Phone No.
ROGER L CARLSON 7B4-6073
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Comparry Name) Contractor License No. Master I.ic. No. (Plant Elect. Only)
MA�TER ELECTRIC CO.,INC. CA01192
Mailing Address (Con[ractor or Owner Performirg Installation)
1�46? BOONE AVE 5.6AVAGE KN. 55378
Authorized Signature Co tractor or Owner Pertorming Installation) Phone No.
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EB-0OOO7A-11 8/95 STATE BOARD COPY - SEE INSTRU O K�F YELLOW COPY