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REQUEST FOR ELECTRICAL INSPECTION ��a��;,
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. X 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 copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection 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 TOTAL
Sign/Outline Ltg. Xfmr. 15. S0
Alarm/Remote Control
Swimming Po I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Special Inspection ��
Final �� _�
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.
371-672 [7[7� / �r� I
�r ���,��� �
JOB NUMHER #97Ql6000
PLEASE PRINT OR TYPE
Requ�t��el•l � 9� Rough-in inspection required? ❑ Yes [hNO Inspection Other Than Rough-In: � Ready Now ❑ Will Call I
(You must call the inspector when ready) Date Ready: � 1 7� 7 I
I, �] licensed contractor ❑ owner hereby request inspection of the above electrical work at: I
Job Address (Street, Box, or Route No.) City Zip Code I
Q173?0 TEMPO TER NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County II
ANOKA
Occupant Phone No.
DARLYS H MELSOM 784-86�4
Power Supplier Address
N P MPLS OF'�'ICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO. IMC. CA011�32
Mailing Address (Contractor or Owner Performing Installation)
Author � n ure (Contractor or Owner Performing Installation) Phone No.
M � �
EB-00001A-11 /95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY