P - 81352,' I IIIII II II III I IIII III I I(II II I(I REQUEST FOR ELECTRICAL INSPECTION ���;;�,
Minnesota State BoaM of Electncity ��rs-
1821 University Ave., Rm. 5-128, Si. Paul, MN 55104 �.��'
* 0 3 9 2 3 5 6 2* Pno�e(sizJSaz-oaoo
Home Duplex Apt. Bldg. Other: New Addn
1ir Cond. Htg. Equip. Water Hh. X Load Mgmt. Other:
)ryer Range Elec. Heat emp. Service
above the wurk coveretl by this request Enter iemarks in this space and on the back of ihe white copy
�AVEA'S SWITCH I2VSTALLATION
Calculate lr�.g�ection Fee - This Inspection Request will no[ be accepfed without the cwrect tee:
Other Fee � Service Entrance Size Fee � CircuRS/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 TOTAL
3. Xfmr.
Control
�. 50
owuiuuu iy r �i I herebL certity tM1at I Inspecled �he elacVlcel Installallon tlascribetl herein on tM1e tlates sta[ed
Irrigation aougn-m oa�e
X Speciallnspection . 50 ,
Final 0 Sq
Investigative Fee �� — Z d' / (
THIS INSTALLATON MAV BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
, OFFICE USE ONLY This request wia 18 monihs irom vallda[ion tlate prin�ed In ihls box.
392-35C�2] � i.� �
/026
sos Nl1MBER ay�mEm¢,m
PLEASE PRINT OR TYPE
ae9°� iaP 30 /,38 ao�en-��„ msoe���o�,ea��,eo? p ves p�o msoe�no� ome, rna� ao�an-m�. � ae�ay Now p w�u cau
(YOU must call ihe Inspector whan reaay7 Da�e Ready: ,�
I, � licensetl contractor ❑ owner hereby request inspection of the above electrical work af:
Job Pitlress ISheet Box, or Route Na_) Ciry Zip Cotle
0��615 N DANUBE RD FRIDLEY 55432
Sec�ion No. iownship Na�ne or No. Rar:ge Na Fire Na Coun�y
ANGHA
Occupant Phorie No.
JEFFERY JAMES' HAGEN 5'71-9441
Wwar Supplier Adtlress
NSP MPLS OFFICE
Elecincal ConUector (Comparry Nams� Contrncior Gcansa No. Mas�er Lic. Nn (Plant Eleot Only�
MAST@R ELEC:TRIC �O. , INC. CA@11'32
Malling Address (Contrac[or or Owner Parforming Installation)
1�4b3 80tJkiE !�l�p,��VAGE MN. 5537d
E6-00001A-11 8/95 STATE BOARD COPV - SEE INSTRUCTIONS ON BACK OF YELLOW COPY