P - 81370I�� IIIII I II I I II I II II II I II REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity � ,_
1821 University Ave., Rm. S-128, St. Paul, MN 55104 ����-
" 0 3 9 2 4 1 1 5* Pno�e �s�2� sa2-oaoo =�•
Home Duplex Apt. Bldg. Other New Addn
I Commercial Industrial Farm Remod Renair
vu Gond. Htg Equip. Water Htr. ^ Loatl Mgmt. Other
�ryer Range Elec. Heat Temp. Service
abwe fhe work covcvetl by this requesi Enter remarks in this space and on the back of the white copy
SAVER'S SWITCH INSTALLATION
Inspectiar Fee - Th�s /nspec6'on Request will not be accepted wfthout Ihe cwrect /ee:
Other Fee +� Service Entrance Size Fee � Cirwits/Feeders Fee
le Home Park Stall 0 to 200 Amps 0 to 100 Amps
•t Ltg./Traffic Sig. Above 200 Amps Above 100_Amps
;formedGenerator INSPECTOR'SOSEONLV TOTA4<-5�
'Outline Lt9. Xfmc �'n
i/Remote Control
If1lI0C,J POO F I hereby certity [M1a� I InspeoteC the elsc�tical Ins�allation tlescdbed herein on IM1e tlates statetl
[ion Boom Rwwn-in oace
Investigative Fee --� . �--!
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
oFFICE USE ONLV This requast vold 18 m s imm valldaUon tla[e printetl in ihis boz.
392-41 �5] � �S �p
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JOB NU,IRER #9�0GC�s00
PLEASE PRINT OR TYPE
Req Rough-in InsOectlon repulred? 0 Yes ❑ o Irs sotion O[her Than R
p agh-In� qeatly Now 0 WIII Cal
�vo� m�s� �u me ��snao�o� wne„ �eaav) oa�e ae�v�. 11 ! 30 / 9&
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at
�ob��d����t�eet.sox,or��t��AN LN NE ��'{IULEY zp���43%
Sec�bn No. Township Name or No. Range Na Fire No. Counry
ntaaxn
G�cupanl Phone No.
BETTY A WICKMAN 571-4913
Power Supplier qtltlmss
NSP MPLS' DFFICE
Eledrical Con[rector (GOmpany Namn) pontractor L�ense No. Master IJo. Na (Plant Elect OnIy)
MASTER ELECTRIC t;O.,INC. CA01292
Malling Adtlress (ConVec�or or Owrer Periorming Installatlon�
12467 BOONE AVE S.SAVAGE MN. 55378
Authorizatl SlgnaWre (Con or Owner Performing Ins I PMre No_
� ������ 941 4?1�/89 ._-t-�
EB-00001A-11 8/95 STATE BOAR� COPY - SEE INSTROCTIONS ON BACK OF VELLOW COPV