P - 84079� RE(�UEST FOR ELECTRICAL INSPECTION ���
I � I IIII�I IIIII IIIII IIIII III�IIIIII IIIII IIIII IIII IIII 1^g21eUn ves ity Ave. rRmf SI 128cSt. Paul, MN 55104 �:`. �'
' * ,t Phone (612) 642-0800 �'�"
0371 6974
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of ihe white copy only.
SAVER'S SWITCH IHSTALLATION
ulate Inspection Fee - This In�oeciion Requesi 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 TOTAL
Sign/Outline Ltg. Xfmr. 15. 50
Alarm/Remote Control
Swimming Poo 1" "� y� I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom � Rough-In Date
Special Inspection 1. S0 � o e �� q r/
Final
Investigative Fee � '�
THIS INSTALLATION MAY BE ORDERED DI ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
v' ` i OFFICE USE ONLY This request void 18 months from validation date printed in this box.
371-697 [� `�,�
/\ � ��� JOB NUMSER #9706000
PLEASE PRINT OR TYPE
Requ�1f8�1'7 � 9'] Rough-in inspection required? ❑ Yes �lo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 10 �], %� 9%
I, �I licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route NoJ City Zip Code
Q15222 PIERCE ST NE , FRIULEY 55421
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant
BERNT A WESTEREN
Power Supplier Address
NSP MPL
Electrical Contractor (Company Name)
MASTER ELECTRIC CO. INC.
Mailing Address (Contractor or Owner Performing Installation)
(Contractor or Owner Performing Installation)
L'! . ►�. , . .
Phone No.
S OFFICE
Contractor License No.
CA011'3:
571-8441
EB-00001A�8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
Master Lic. No. (Plant Elect. Only)
Phone No.