P - 81371CI�I IIIlIIIIIIIIIII IIIIIIII IIIIIlIIIII III REQUEST FOR ELECTRICAL INSPECTION �g��.
Minnesota State Board of Elec[riciry `�
1821 University Ave., Rm. 5-128, St. Paul, MN 55104
* 0 3 9 2 2 9 8 6* Phone (612) 642-0800 ���•-
Home �uplex Apt Bldg. Other: New Addn
Other:
abwe fhe work coveretl by ihis reques[ Entei �emarks in this space antl on the back or tfre wnite copy
SAV�k'S SWITCH INSTALLATION
ulafe Inspection Fee - This In.qoectirn Request will not be accep[ed without the coirect fee:
Other Fee � Service Entrance Sire Fee +� Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps � � �0 to 100 Amps I
Transformer/Generator INSPECTOH'S lISE ONLV "
Sign/Outline Ltg. Xfmr. �,r
Alarm/Remote Control s
awunrn�ny rOO� I hereby cerilly ihat I inspbEtetl the elechicel irstalhation tlesonbetl heroin on �ne tlates s�ated
Irrigation Boom , �.. �� � ao��n-m oate
Special inspection , ja ,
Final D
Irrvestigative Fee �
THIS INSTALLATION MAV BE ORDERED DISCONNECTED IF NOT COMPLETED WIT IN 18 MONTHS.
OFFICE USE ONLY This repuest voitl 18 mon[hs from validation date prin�etl in this box.
392-29� � �a� �
30B NUMRER #98Qr6@P1L
PLEASE PRINT OR TVPE
�9�'��{�9 j�38 Rougnyn[nspectionreq�ntCtl? �Yes �Ja InspevYVonClhvThanPOOgF-1n: � ReatlyNOw � WiIIC
(1'0o muet call the inspoeror when reaAy) �a�e Raetly: 1�/ �(�Cj � c,��j
I, � licensed contractor ❑ owne� hereby request inspection ot the above electrical v✓ork at:
Job Ntltlress �Slreel, Box. or Route NoJ Gity Zip Cade
0E�2:30 TRINITY UR NE r^kFDLEY 5��93�
Sec�ion No. Township Name or No. Rancc Na Fire No. Gaun�y
ANOKA
Occupant Phone No.
IAHES W FALKNER 571-b�D23
Wvrer Supplier Atltlress
NSP MFLS OFEI�E
Elec[dcal Corrtrector (Comparry Name) Gonlraotor License No. Master L�c. No. (Plant EIecL Ony)
MA5'TER ELECTRZ� �0.,3NC. CA0i19�
Me111nB ��se �COnitaoNr or Ownsr Partorming Installation)
or
E&OOOOtA-1i 8/95 STATEBOAHDCOPY-SEEINSTRUCTIONSONBACKOFYELLOWCOPV
Phore No.