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Farm
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REQUEST FOR ELECTRICAL INSPECTION ���,
Minnesota State Board of Elec[ricity � g,_
1821 University Ave., Rm. 5-128, St. Paul, MN 55104
Phone (612) 642-0800 ��'�'��
Other New Addn
Other:
in this s,oace antl on the back o/ the white copy only.
SAV£A'� SWITCH INSTALLATIOM
Calculate Nspection Fee - Th�s Inspection Repuesf will nof be accepted without the conect /ee:
Other Fee +s Service Entrance Sire Fee x 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
TransformeNGenerator INSPECTOR'S USE ONLV TOTAI� / 5�
SigNOutline Ltq. Xfmr. f9
Alarm/Remote Conhol
Swimming I I heret certity mat i�insoeded me elacincai �ins�ailat'an aesoribec herein on the tletes stated
Irrigation Bo aouyn-m oare
Special Inspection • •�
Fmei oat� �
Investigative Fee 2 Z _
„ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This repuest witl 1B monNS �mm valltlation tlate pnnted'm �his �x.
392-37�8] �/a6 5 �
SOB NIJMHEk #'�N60C�i�d
^e4 2�Y�.110 / 7L5 Pou9h-�n Inspection require44 p Yes Q}(lo Inspectlon Othe� ThanROUgh-la [
�VOU mwt call Ihe insPecNr when ready) oate Reedy
I, u licensetl contractor ❑ owner hereby request inspection of the above electrical work at
Job Ftltlress (Street, Box, or Rwte No.) Ci[
0I515 MISSISSIPPI ST NE F�?IDLEY
SecNon No. Township Name or IJO. Farge Nn Fira No_ County
ANUKA
0
LLOYD
Powzr Supplier Atldress
NSP MPLS OFFICE
ElecVical Conireo�or IGOmpany Nams) Contractor IJcense No.
MASTER ELEL'TRIC CO.,INC. CA01192
Mailirg Address (GOntractor or Owner Performing Installa9on)
12457 HOONE AVE S.�AVAGE S�N. 55378
AWhodzed S'gna�y[@ (GOntaator or Owner Parformin9lnstallrLlonl
ftearly Now � Will �
11/30/98
Zlp Cotle
5543;1
527-1961
Master Llc. No. fPlant Elect Onry)
i r�x� ���un� 941}97
EB-00001A-11 B/95 STATE BOARD COPV - SEE INSTHUCTIONS ON BACK OF VELLOW COPY