P - 81355�IIIIII�IIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIII M8 � �ose saO B aLRo SRe'C8�L5 N3PErCNI0N04 �y�'F�:.
* 0 3 9 2 3$ 4 4* Ph�e�siz>sa2-aaoo ���
�me Duplex Apt Bldg. Other: New Addn
Htg Equip. Water Htr. n Load Mgmi. Other.
Range Elec. Heat emp. Service
wnrk covered by this request Enter remarks in this space and on the 6ack ot the white copy only.
SAVEk'S SWITCH INSTALLATION
u!a(e !n`pecGbn Fee - This 7nSpecfion Reque5! will not be accepted without [he wrrect fee:
Other Fee ++ Service Entrance Size Fee � Cirwits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street LtgJ7raffic Si9. A6ove 200_Amps Above 100_Amps
Transformer,'Generator �NSPECTOH'S USE ONLY TOTAL �
Xfmr.
•..
installaFron tlescribad herain
S�
. InvestigativeFee �� �._1c„_.(�x.- r �/�'j
' THIS INSTALLATION MAY 8E ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MON7HS.
OFFICE USE ONLV This reQuest vatl 18 mnnths hom valvlaCUm daW printed in this box.
392-38� � �s �
JOB NUMBER #5$PJ6�08
PLEASE PRINT OR TYPE
Reque£� �at��0 /�-j�j Rcugh-in inspecbon requiretl9 � Yes O�o IrSpecM1On Other Then RqyMa [� Refldy Now � WIII I
(Ynurtu4stcalliF�e'inspectorwF�enreadyi DateReatly Z1J'�0/%J�j
I, � licensetl cootractor ❑ owner heieby request inspection of the above electrical work at:
Job Address i5heel, Box, or Route NoJ Clly Zlp Code
06?47 DVEHTflN DR RE FkIDLEY 55A32
Sectlon No_ Tcwr�shtp Name w IJO_ Rarge No. Flre Na � Cwnty
nxnxn
Occupant PrWrie No.
PATRICIA 5 MUR2YK 572-9fi29
Power Supplier Atldrsss
NSP MFLS 6FFICE
Eleciraal Gontracfor (Comparry Neme) Gonhactor Goensa No- Master Gc No. (Plen� EIecL Only�
MASTER ELECTRIL Ct7. , It+[C. CA@119�
Mailirg Atl�ress (Goninc�or or Owner Performing Ins�alletlon)
124b7 BL70NE AVE �.S'AVAGE MN. 55378
/85fb`3S5
' EB-00001A-11 B/95 STATE BOARD COPY - SEE INSTflUCTIONS ON BACK OF VELLOW GOPV