P - 84093i REQUEST FOR ELECTRICAL INSPECTION
I I�II�IIIIIIIIII IIIIIIIIII IIIIIIIIII IIIIIIIII III) 1n821eUniveSsty A earRmf Sie 28cSt. Paul, MN 55104
� * 0 3 7 1 6 1 1 5* Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remo
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 copy only.
SAVER'S SWITCH INSTALLATION
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Calculate In�oeciion Fee - This Inspection Request will not be accepted without the correct tee:
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 TOTA� 5. 50
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Poo �, /" •� I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom � � ti Rough-In Date
Speciallnspection '
Final Date
Investigative Fee �- l ° `f�
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.
371-611 [� ��
/��(D'�/� JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Requ e Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 10 � 17 � 97
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�°��c�"eet, B°x, �.`��pCl TER NE �i�I DLEY Z"��432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occu ant Phone No.
N�NA F AHDERSON 763-8979
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAVAG „�[H. 55378
Auth�j�ature (Contractor or Owner Performing Installatio � z'"I p' ' , Phone No.
1 S/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY