P - 83713I l�11if II II I I IIII II III IIIII III II IIIII III II I III IIII
*03639747
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 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 cqoy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted without ihe 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 ONLV TOTA15.
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Special Inspecti n
Final Date
Investigative F ' Z� —
THIS INSTALLATION MAY BE ORDERED DISCON ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
363-974 � �
��.r`�—� '� '�38� JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Request Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: % I �. % I 9%
I, [� licensed contractor ❑ owner hereby request inspection of the above electrical work at:
J�061s�1(sitreet,eoX,oS�A��.ITE BLV HE �t�IDLEY Z�P55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
KIlt M VERBRUGGE 572-0481
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER E[.ECTRIC C0. , INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAVAGE hN. 55378
Autho � d Sig ture (Contr tor ner Performing Insta o `, Phone No.
3 v� 941 4712 / 890— 3555
EB-OOOOtA-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY .