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*03798$24*
RE(�UEST 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 �� S C Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by ihis request. Enter remarks in this space and on the back of the white cqoy only.
SAVER'S SWITCH INSTALLATION
Calculate Ins,oection Fee - This Inspection Request will not be accepted without the conect fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Tratfic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL S'b
Sign/Outline Ltg. Xfmr. 15.��
Alarm/Remote Control
Swimming Po I hereby certify thaT I inspected the electrical installation described herein on the dates stated
Irrigation Boo Rough-In Date
pecial Inspection • 0 ma�
Investigative Fee � - �— �
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.
379-882� �
/�'� 5�
�� �3�� JOB NUMHER �970600
PLEASE PRINT OR TYPE
Request Da� � 19 � 98 Rough-in inspection required? ❑ Yes ❑ Nox Inspection Other Than Rough-In: ❑ f�eady Now ❑ Will Call
(You must call the inspector when ready) Date Ready:
I, ❑Xjcensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) Ciry Zip Code
01055 FILLMORE CIR FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
CONSTANCE J MEYERS 574-0518
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Comparry 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 KN. 55378
Authorized Signa r tractor or Owner Performing Installation) �[, '? Phone No.
V U
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY �