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*03869948*
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
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Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this request. Enter remarks in this $oace 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 n 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
Sign/Outline Ltg. Xfmr. 15. $0
Alarm/Remote Control
SWIIIIfTllll9 POOI I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
pecial Inspection 1 S. 0
Investigative Fee ��� Da�r��^�
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 rtwnths from validation date printed in this box.
386-994 • i� �
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JOB NUMBER #970600
PLEASE PRINT OR TYPE
Request Da� � 14 / 98 Rough-in inspection required? ❑ Yes ❑ Nox Inspedion Other Than Rough-In: ❑ 1l�ady Now ❑ wll Call
(You must call the inspector when ready) Date Ready:
I, ❑�censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
00901 OVERTON DR NE FRIDLEY 55432
Section No. Township Name or No. Rarx�e No. Fire No. County
ANOKA
Occupant Phone No.
GLENN R VAN HULZEM 571-2373
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC C0. INC. C 01
Mailing Address (Contractor or Owner Performing Installation)
Author' Signature (Contractor or Owner Performing Installation) Phone No.
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EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIO LLOW COPY � �