P - 80798..
0 854-641
❑ REQUEST FOR ELECTRICAL INSPECTION _
8 Minnesota State Board of Electricity
1821 Universiry Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.e/ectricity.state.mn.us � : '
Home Duplex Apt. Bldg. Other: New Atltln
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
'X" above the work covered by this request Enter remarks in this space and on the back of the white copy on/y.
NSP SAVER'S SWfTCN IN5TALLA7iON
Ca/cu/ate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
�ther Installations Fee # Service E�trance 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.
Alarm/Remote Control
Swimming Poo
I hereby certity that I inspected the electrical installation described herein on the dates stated:
Iff198t1Of1 BOOIII Rough In Date
� � Investigative Fee � � ��/ �-�-�"` � j'v "rL{ �' .
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED ITHIN 18 O F
............. .. ................................�.._,.....r..•,.•.....w,.�.....W�...,..,...�W................,.............a.,�»...........�w...,.................�......- -
OFFICE USE ONLY This request vad 18 moMhs from validation date printed in this box.
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Request Date Rough-In inspection required? ❑ Yes ❑ Inspection Other Than RougFNn: ❑ Ready Now ❑ Will Call
��� You must call the inspector when readyr.� Date Ready: ��
I, []Qicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
�o�yp� (Street, �L�i"i�� 01y FRIDLEY z�P coa�,.l421
t,s��ou
Section No. Township Name or No. Range No. Fire No. Counry �
� L4� L Phone No. ��� r��d�.�
Powaratupplier Addr�s�,,,, S �Fl r�
IV�N'� IMR"L
Electrical Contractor / Com an Name Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTEi� ELEC�R�C CO., IWC. CR07191
Mailing Address (Contractor, Company or Owner Perfarming Installation)
12467 BOOt� AVE S. SAVAGE, t+rNU. 5537$ (B12jQ41-4712 !(B12j�it1-35l�
Authorized Signature (Contractor, C wner Pertorming Installation) Phone Number
_ � /
E&00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY