P - 80295`�
- �-852-999 02
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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity -
1821 University Avenue Suite S-128, Saint Paui, Minnesota 55104-2993
(651) 642-0800 www.e/ectricity.stafe.mn.us � : � •'
Home Dupiex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. X Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
X" above the work covered by this request Enter remarks in this space and on the back of the white copy only.
Calculate
Mobile Home Park Stall
Street Ltg./ Traffic Sig.
Sign / Outline Ltg. Xfmr.
Alarm/Remote �ipqtW,L.
N5P SAVER'S SWtTCH INSTALLAl10N
Fee - This Inspection Request will not be accepted without fhe correct fee.
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
0 to 100 Amps
Above 100 Amps
TOTAL
20.50
- I hereb certify that I inspected the electrical installation described herein on the dates stated:
Irrigation Boom Rough In Date
Speciallnspection �,5Q
Investigative Fee F�nai o te 3 d— o
THIS INSTALLATION MAY BE ORDERED DI ONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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`� OFFICE USE ONLY This uest void 18 moMhs from validation date rinted in this box.
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D 7D JOB�BER #9�6�0
*08529992*
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required?}[7 Yes ❑ No Inspection Other Than Rough-In: Ready Now O Will Call
'�2��� You must call the inspector when ready! Date Ready: ��7�g
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code:
t�181 RIVERVIEtiYIERNE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant Phone No.
BECKh11EN RICHARD J (672)717-2328
Power Supplier Address
N� MPLS OFFICE
Electrical Contraaor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELEC7RiC CO., INC. CA01192
Mailing Address (Contractor, Company or Owner Pertorming Installallon)
'l24S7 BOONE AVE S. SAVA,r.�E. MN, 55378 ($'12)941-i1712 (B12)894-355
uthorized Signature (Contractor�o��or Owner Performing Installation) Phone Number
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�B-00001A-12 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY