P - 83449i REQUEST FOR ELECTRICAL INSPECTION ���,
j�I��I�IIIIIIIIIIIII�IIII�III��II�IIIIIII�IIIIIII 1ng21eUniveSsty A earRmf SI 128cSt. Paul, MN 55104 �,� �.�'
* O 3 7��.� 2 O* 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 ihis requesi. Enter remarks in this space and on the back ot the white copy only.
SAVER'S SWITCH INSTALLATION
3lculate Inspection 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 INSP£CTOR'S USE ONLY TOTAL
15. 50
Sign/Outline Ltg. Xfmr.
Alarm/Re
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
; Speciallnspection 1. 50 Finat Da
Investigative Fee �G � 2 � �
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.
378-912�] ,s �
�/3 �
JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Reques��te� 6� C38 Rough-in inspection required? ❑ Yes �lo Inspection Other Than Rough-Irc �{ Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 6/ j fj I 98
I, L licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route No.) City Zip Code
00593 RICE CREEK TER NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
WALTER E SAMUEGSON 571-8042
Power Supplier Address
NSP MPLS OF'FICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
liASTER ELELTRIC CO. , INC. CA01192
Mailing Address (Contractor or Owner Pertorming Installation)
1246? BOONE AVE S. SAVAGE MN. SS378
Ayt�orj;ed S�ature (Contractor or Owner Performing Installation) Phone No.
EB-00001A-11 �/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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