P - 83700/�( I��11 „III IIIII IIIII II I
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*Q3639689*
REQUEST FOR ELECTRICAL INSPECTION ���
Minnesota State Board of Electricity � �=
1821 University Ave., Rm. S-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 Temp. Service �
"X" above fhe work covered by this requesL Enter remarks in this space and on the back of the white cqoy only. I
SAVER'S SWITCH INSTALLATION
Calculate lnspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee � 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 TOTA�S. 0(`i
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Special Inspection
Final p �
Investigative
THIS INSTAL `�s� Y(.^E ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
363-968� � ���
���5� JOB NUMBER #�970b000
PLEASE PRINT OR TYPE
Request'Ija� 17 �C3'7 Rou h-in ins ection re uired?
9 p q ❑ Yes �{Jo Inspection Other Than Rough-In: �( Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: '� � 1'J � t3^�
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
00187 PAHORAMA AVE FRIDLEY 55421
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
HARVIN A TOIiALA 572-8716
Power Supplier Address -
NSP MFLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,IHC. CA@1192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAVAGE MN. 55378
Au ed Sign tu (Contrac r r Owner Performing Installation� - Phone No.
5� ��C? 941 4712/890-3555
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY