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REGIUEST 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. 3{ Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this request Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate In ,soection Fee - This Inspection Request will not be accepted without the cwrect 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
Sign/Outline Ltg. Xfmr. � 50
Alarm/Remote Control
Swimming Pool I hereby certi(y that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In oace
X Speciallnsp ' r 0 �
Final Da
Investigative e
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED N 18 MONTHS.
------------------------------ - --�. _-,__,_�_.—_v
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
.392-34�] ��� l.�
JOB HUMBER #9�6000
PLEASE PRINT OR TYPE
Reque� �ajp 30 / c,8 Rough-in inspection required? ❑ Yes ❑�o Inspection Other Than Rough-�n: � Ready Now 0 Will Call
(You must call the inspector when ready) Date Ready: 1 1 I30� 98
I, �y licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
06320 OUIHCY ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
TAURA R DELAHEY 5'71-0734
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Company Name) Conhactor License No. Master Lic. No. (Plant Elect. Onty)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOOHE AVE S.SAVAGE MN. 55378
Authorized Signature (Contractor or Owner Performing Installation) PFrone No.
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�( c.7' 941 47 2/89 — 5
EB-00001A-11 S/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY