P - 83703P I I1i11111111 IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII
*03639622*
REQUEST FOR ELECTRICAL INSPECTION ���
Minnesota State Board of Electricity � �
1821 Universit y 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. 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 the white cqoy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted withoui 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 TOTALS. 00
Sign/Outline Ltg. Xfmr.
1
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 /� �� �
Investigative -�t""-�— �
THIS INSTAL A O E ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� � OFFICE USE ONLY This request void 18 months from validation date printed in ihis box.
363-962 � � ��� •
! 5�,,50
JOB NUMBER #�9706000
PLEASE PRINT OR TYPE
Rough-in inspection required? ❑ Yes ❑itlo Inspection Other Than Rough-In: [�C Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: %� 1%� 9%
I, Q licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�o��s�,�Street, Box, o������ cuRVE �'t�2IDLEY Z'��432
1
Section No. I Township Name or No. I Range No. I Fire No. � County
ANOKA
Occupant Phone No.
DAC.E D SWAHSOH
Power Supplier Address
NSP liPLS OFFICE
Electrical Contractor (Company Name) Contractor License No.
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S, SAVAGE liN. 55378
Autho ' Signa r Contracto r Owner Perforrtynp Ip�tal on1
�VtJ��,� 941
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPI
574-1969
Master Lic. No. (Plant Elect. Only)
Phone No.
4712/890-3555