P - 83441- �If9filllllllllllllllllllflllllllllllllflfllllllll
*03788965*
REQUEST FOR ELECTRICAL INSPECTION �TM��,
Minnesota State Board of Electricity � °'
1821 University Ave., Rm. S-128, St. Paul, MN 55104
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 this request. Enter remarks in this space and on the back ot the white copy only.
SAVER'S SWITCH INSTALLATION
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 TOTi4�5. 50
Sign/Outline Ltg. Xfmr. 1
AlarrrF/ 6 0l
Swimming OOI I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Special Inspection
Final Datv_ _> 7 �j'�
Investigative Fee / "-""�•� i i
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.
378-896�5 � �����s, �
JOB NUMBER #�9706000
PLEASE PRINT OR TYPE
Request��l � g8 Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
(YOU must call the inspector when ready) Date Ready. fj I 1 G I 98
I, u licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) Cit Zip Code
07130 RIVERWOOD DR HE F�?IDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
THOMAS D KUPP 571-8227
Power Supplier Address
N5P MPLS OF'FICE
Electrical Conhactor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
124b7 BOONE AVE S. SAVAGE nN. 55378
orized Signature (Contractor or Owner Performing Installation) Phone No.
2 6� r 941 4712/890-3555
EB-00001A- 1 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY