P - 83438� I�II� ��III �I�II III�I IIIII I��I) II�II I�III �III ��II
REQUEST FOR ELECTRICAL INSPECTION �,��
Mlnnesota State Board of Electricity � ''
1821 University Ave., Rm. S-128, St. Paul, MN 55104
* 0 3 7 8 9 0 6 2* Phone (612) 642-0800 �`�"�
Home Duplex Apt. Bldg. Other: New Addn
Commercial fndustrial 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 cqoy only.
SAVER'S SWITCH INSTALLATIOH
Calculate In$oection Fee - This Inspection Request 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. 1S. 50
Alarm/Remote Control
SWIfTI I�y �' I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation 00 Rough-In Date
X Special Inspection 1. S0 �
Final ' � . Dffi _ � /-
Investigative Fee � 'S — %y
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.
378-906�] �s-�
_ ��3,�
J�B HUMBER �t9706000
PLEASE PRINT OR TYPE
Reques��16 � gg Rough-in inspection required? ❑ Yes �QVo Inspection Other Than Rough-In: �' Ready Now ❑ Will Call
(You must call the inspector when ready) �ate Ready: 6/ 1(,� / cjS
I, 1*] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
00461 RICE CREEK BLV NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. Counry
ANOxA
Occupant Phone No.
ERIC D OSGOOD 571-5001
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BODNE AVE S. SAVAGE MN. 553?8
A ri d Si nature (Contractor or Owner Performing Installation) Phone No.
EB-00001A-11 /95 STATE BOARD COPY - SEE I 7y7NOy,��ACK OF YELLOW COPY
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