P - 83556I II����IIII IIIII IIII) IIIII IIIII IIIII IIIII III) IIII
` *03923331*
REQUEST FOR ELECTRICAL INSPECTION ���
Minnesota State Board of Electricity � �'
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone (612) 642-0800 �"�`'i
Home Duplex Apt. Bidg. 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 of the white cqoy only.
SAVER'S SWITGH IHSTALLATION
Calculate lnspection Fee - This Inspection Request will not be accepted without the 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 ONLY TOTAI,/� 50
Sign/Outline Ltg. Xfmr. f
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In oare
Special Inspecti
. Flnal Date �i�
Investigative Fee — b ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WIT IN 18 MONTHS.
__._�- --- ----- -,.-_w.�______,-,-,-- ,----z�-•�.,_,
OFFICE USE ONLY This request vdd 18 nths from validation date printed in this box.
392-33�1 " �-, �552�
3os Kur�B�R ��6m�a0
PLEASE PRINT OR TYPE
� e Rough-in inspection required? 0 Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: i 1 I 3OJ I 9�
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�o�r��c,�treet, Box, o�Ft�ut��o,�R ST NE ��2I DLEY Z�p�432
Section No. Township Name or No. Range No. Fire No. County ANOKA
�E�`��.ENE J BREFFLE P��e N� 571-4461
Power Supplier Address
NSP IiPI.S OFPICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Insiallation)
i2467 BOONE AVE S. SAVAGE MN. 55378
Authorized Signature (Contractor or Owner Perfwming Installation} 1� . Phone No.
� �' 941 4712/890-3555
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