P - 82850IIiI� IIIII IIIII IIIII IIIII IIIII III� IIIII IIII 4IIl
*03798758*
REQUEST FOR ELECTRICAL INSPECTION �,���
Minnesota State Board of Electricity `"
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone (612) 642-0800 � `
� ieay�
Home Duplex Apt. Bldg. Other: S� New Addn
Commercial Industrial Farm �^� Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enier 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 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 TOTAL 15. �
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
rigation Boom Rough-In Date
pecial Inspectio
Final � �� Date q
Investigative Fee � / '^
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.
379-875� �
�����lo�l��� JOB NUM$ER �970600
PLEASE PRINT OR TYPE r✓
Request Da Rough-in inspection required? � Yes ❑ N Inspection Other Than Rough-In: � ady Now ❑ Will Call
(You must call the inspector when ready) oate rteady: G/ �. J/ 98
I, ❑ icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job a�����,c, BoX, o, R�bRY LN NE c�t'�'R I DLEY Z�P �5432
Section No. Township Name a No. Rarge No. Fire No. County
ANOKA
Occupant PFrone No.
STANLEY W LEINO 784-7687
Power SUpplier Address
NSP KPLS OF'FICE
Eiectrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elec[. Ony)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owrrer Performing Installation)
12467 BOONE AVE S. SAVAGE 1�N. 55378
Authorized Si Contractor or Owner Performing Instaliation) , Phone No.
94 -4712/890-355
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY