P - 83434���� IIIII IIII) IIIII IIII) IIIII �IIII IIIII �III IIII
*03789047*
REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity � `"
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 �`-'-°�' ``s
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 emp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy oniy.
SAVER'S SWITCH INSTALLATIOH
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct tee:
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/
Swimmi g I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In oa�e
X Speciallnspection 1 . 50
Final Dat
Investigative Fee d— —�'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
378-904�] � l �S.Sd
�l .�
JOH NUMBER #9706000
PLEASE PRINT OR TYPE
Reques��16 / 98 Rough-in inspection required? ❑ Yes [�Jo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 6� 16I98
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
05651 REGIS DR NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
NGA NGUYEN 574-9597
Power Supplier Address
NSP MPL.S OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELELTRIC C�7. � INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BO�NE AVE S. SAVAGE MN. 55378
th � ed Signature (Contractor or Owner Performing Installation) Phone No.
� 941 4712/890-3555
EB-00001A-1 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY