P - 81353��i��llllll �IIII �IIII ��I� I�I � II I III � IIII IIII
*03924040*
REQUEST FOR ELECTRICAL INSPECTION �,�+?��s;�,..
Minnesota State Board ot Elechicity ���
� �-
1821 Universiry Ave., Rm. 5-128, 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. X Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work coveretl by this requesL Entei remerks in this spyce and on the back ot ihe white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - 7his Ins,oeCtion Requesf will not be accepfEd wiihout the correct lee:
Other Fee � Service Entrance Size Fee � Circuils/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 INSPECTORSUSEONLY TOTAL,/�
Sign/Outllne Ltg. Xfmr. {,D� SQ1
Alarm/Remote Control
Swimming Po i ne�eby �zrtt� ma� i���spe�ea me �i�o�ecai ���stau�aoo aeso��eea no�om o� mE aa�es sr��ed
Iffig3ti0f1 BOO�YI Rough-Ir Date
X Speciallnspection 1. 50 F��ai � r oa�P
Investigative Fee � z d—
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request wid t8 mon�hs irom valitla[ion date printeC In ihls box.
392-40�0 ��, �
�a6
JOB NUMBEk tl9�06000J
PLEASE PRINT OR TYPE
Requ� ��3� �9g Rough-in InspecHon requirotl2 0 Ves 0'�o Inspec�lon Other Than Ro�gh-I¢ [t( ReaAy Now 0 Will Call
l,YOU Tusl :.ail (he Irispeciw when reetlyl Date Reatly: ����Q� ��
I, �] licensed conhector ❑ owner hereby request inspectlon of the a6ove electrlcal work at
Jab Atltlross (S��ast Box, or Raite No_) Clty Zip Gotle
rl§25 N INHSHRtJCK Dk FRIDLEY 5543�
Seotion No. Townshlp Name or No. Range Na Fra No. County
ANOKA
Occupant Phone No-
DAN TEAZIGH 574-0898
Pov✓er SLppIIe� AdCress
NS'P MPLS OFFIGE
ElacVicel GonUector (Company Neme) Conhacior Liosnsa No. Master IJO. No. (Plant Elect Only)
MASTER ELECTftIC CQ„ IH�. CA0119'�
Mailing Pdtlress (COnVector or Owner Pedorming Installatlon)
12467 6t�ONE AVE S.SAVAGE MN. 55378
AW�orizetlSlgnaWre(GOnU orOwnerPerfaminglnsGllaHm)� PFrorieNO_
941 +�71?; 89
— � _� �� _�
EB-00001A-11 8.�95 STATE BOARD COPY - SEE INSTRIICTIONS ON BACK OF VELLOW COPV