P - 81364l�l � II (I I I I IIII I I I I I I I II
*(1 RQ'J.'3R � 'J *
RE�UEST FOR ELECTRICAL INSPECTION s^�
Minnesota State 8oard of Electricity � �s',
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-OSW �`��!�a" ��
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indushial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt Other
Dryer Range Elec. Heat Temp. Service
"X" above fhe work coveretl by th�s request. Enter remarks m Ihis $oace and on the back of the whi[e copy only.
SAVEk'S SWITCH INSTALLATION
Calcula[e Inspecfion Fee - 7his lnspectiar Request wi!! not be accepfetl without the covect lee�
Other Fee � Service Entrance Size Fee � Circuits/Feetlers 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 INSPECTOfl'S USE ONLV TOTA�! 50
Sign/Outline Lt � f . a
Alarm/Remote I
Swimming Pool ���epy �e�pry �net i Irispemed the eleancJ instellation descnbad here�n or tne aates sha�etl
Irrigation 800m ao�,-m oa+�
� Speciallnspection
Final Da�
Investigative Fee ' Z — �
THIS INSTALLATION MAY BE ORDERE� DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY Thls reques� voitl 18 s �rom validation tla[e prir[etl in �his box.
392-36� � (a��5. �v
10B NUMBEk 115�06tn0�D
PLEASE PRINT OR TYPE
Requ Rouoh-in inspecllon required? � Yas ❑ Inapedlon OtM1er Than Rough-Irt RPatly Now � WIII Cell
ivo� m�st can me msaectar when reday� oate Fteady. 11 / 3Q� 1�J�3
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�ob�r�5��5Utreetsox.or���n��y��UUD DR NE �vRIDLEY Z�P�e432
Sec�ion No. Township Name or No. Ranoe Na Fire No. County
nxoxn
a�Pa�r Pno�a No.
RICHARD G JAHSEN 572-6534
Power Supplier Address
NS'P MPLS OFFICE
Eleotrical Con�rac�or (GOmpany Name) ConVaGOr Licerise Na Master Ge. No. (Plan� Elact Ony)
[4ASTER £L£C'S'RIC CO. , IHC. CA01192
Mailing Address �Conhatlor or Owner Porforming Insiellationl
12467 BOONE AVE S.SAVAGE MN. 55378
Autho�izetl SignaW 'GOnVaclor or Owner Performing Installa�ion) �s Plrone No.
2iJ��'."� 941 4712/89p�-3�„
EB-OOOOtA-11 8/95 STATE BOARD COPY - SEE INSTFOCTIONS ON BACK OF VELLOW COPV