P - 81368', li� IIII III I IIII II IIIIIII I II
*03923869*
REQUEST FOR ELECTRICAL INSPECTION e��;�..
Minnesota State Board of Electriciry �` `�
1821 University Ave., Rm. 5-128, SL Paul, MN 55104 �'����
Phone (612) 642-OS00 �'!� �°
Home Duplex Apt.8ldg. Other: New Addn �
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Wa}er Htr. Load Mgmt Ofher
Dryer Range Elec. Heat Temp. Service
"X" above the work coveied by this iequesL Enier remaiks in fhis space and on the back ol [he white copy arry.
SAVER'S SWITCH INSTALLATION
Calculate InspeCtion Fee - This Inspection Request will not be aCCeptetl wi[hout the correcf fee: '�.
Other Fee � SefviCe Entrance Si2e Fee � CifCUits/FeetleS 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 TOTA
Sign/Outline Ltg. Xfmr. � 5�
Alarm/Remote Control
Swimming POOI I hereby csrbfy ihat I lnspectetl the electncal Installatlon described herein on Ihe dates statetl
IIIigBfion BOOm N Rou�h-In Date
X Special Inspection 1. 50
Final De(e)
Investigative Fee �" —
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. �
__.y_ ______________.:'—_ .T_Y____._.'_�_-- �
OFFICE USE ONLV Thie request wid i8 m� irom valitla[ion dale printed In ihis boz.
392-38F� /�6S- .�
JOB NUMHEk ri�0600N
PLEASE PRINT OR TYPE
Requc�t Qa� 30 � 98 Rwgh-m Inspection requiretl? 0 Yes ��lo Inspec�ion O�her Than Rough-In: �{ Reatly Now 0 N✓II Gall
(You musi oell �he ins0ector when reatly� Dete Rsatly 11 � 3Qj � 9�j
I, u licensed contractor ❑ owner hereby request inspection of the a6ove electrical work at �
.bb Atltlress (SVaet, Box, or Rou�e No. Gt Zip Cotle �
05876 STIN ON BLV F�2IDLEY 55432
Sedan No. Township Name or No. Range No. Flre No. Gounry
ANUKA
Occupanl Phone No.
RALPH R NIELSEHI 571-0602
rmwe, s��nP, nad,ess
NSP MPLS OFFICE
� ElecVical Gonkactor �Comparry Namel ConUacior pcense No. Master Lic. Na (Plart Elect Onry�
MASTER ELECTRIC Cu.,INC, CA011'32
Maillrg Atltlress (Contractor or Owner Performiny Installatlon)
1'2457 Bt7t7HE AVE S.SAVAGE MN. 55378
Huthorized SignaNre �Conhactor or Owner Psrlormin�talJytion) Phone No-
6 41 471 'i 89
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E6-OOOOtA-11 8/95 STqTE BOAFlO COPV - SEE INSTRIICTIONS ON BACK OP VELLOW COPV �