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REQUEST FOR ELECTRICAL INSPECTION �'��
Minnesota State Board of Electricity � °i'
1821 University Ave., Rm. S-128, St. Paul, MN 55104 ,,,�
Phone (612) 642-0800 ��"� "" �
Home Duplex Apt. Bldg. Other: ,�I New Addn
Commercial Industrial Farm �v S e' 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 ot the white copy only.
SAVER'S SWITCH IHSTALLATION
Calculate 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 INSPECTOR'S USE ONLY TOTAL 15.'@�
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
rigation Boom ough-In Date
Special Inspecti
Final Dat
Investigative Fe " � —
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.
379-877�] � � �a .
' � � �)� JOB NUMBER #970600
PLEASE O TYPE
Request Da Rough-in inspection required? ❑ Yes ❑ N Inspection Other Than Rough-In: ❑ ady Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 6/ 19 / 98
I, ❑ licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�°b "�gs�t, B°", °` R�i��RV IEW TER NE c'`'�'R I DLEY Z'P �5432
Section No. Township Name or No. Range No. Fire No. County ANOKA
°°�°P�'bEL D MARQUAROT P�neNo. ,786-0808
Po�r�� Address MPLS OF'F'ICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Ony)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAVAGE MN. 55378
Authorized Signa ur (Contractor or Owner Performing Installation) �� . Phone No.
94 —4712/890-355
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY