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*03923364*
REQUEST FOR ELECTRICAL INSPECTION ���
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 Gond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this request Enter remarks in this space and on the back of the white copy only.
SAVEk'S SWITCH INSTALLATION
Calculaie Inspection Fee - This InsAection Request will not be accepted without the cwrect 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 ONLV TOTAL
Sign/Outline Ltg. Xfmr. ,�'- 5�
AlarmlRemote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
X Speciallnspecti
Final Da
Investigative Fee ^ Z
THlS INSTALLAIION MAY BE ORDERED DISCONNECTED iF NOT COMPLETED W THIN 18 MONTHS.
___�_____ _�_�----�---___—�---- - -__-.- ---._,_._.__�.._____�._.____« _
OFFICE USE ONLY This request vad 18 months from validation date printed in this box.
392-33F�4 ��� �,�s-�
30B NUMBER #9�J06000
PLEASE PRINT OR TYPE
Reque3t ia� 3(lj / 9B Rough-in inspection required? ❑ Yes ��Qo Inspection Other Than Rough-In: [}{ Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 11 I30I98
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
,bb Address (Street, Box, or Route No.) City Zip Code
08121 RUTH CIR NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. Cqunty
ANOKA
Occupant Phone No.
GINGER L CARLSON 786-5390
Power Supplier Address
NSP KPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
l4ASTER ELECTRIC CLI. � INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOOME AVE 5. SAVAGE MN. 55378
Authorized Signatur Contractor or Owner Performing Installa�op)� y�� r� � Phone No.
�� � 941 4712/890- 5 5
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY