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REQUEST FOR ELECTRICAL INSPECTION ��,�
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 'S � �� Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this request Enier remarks in this space and on the back of ihe white cqoy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This lnspection 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. �'
Alarm/Remote ontrol
Swimmirig Po I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
pecial Inspection
mal D
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.
379-832�9] �v �
i5 ��
��19 JOB NUMBER �970600
PLEASE PRINT OR TYPE
Reques[ Da� � 19 � 9$ Rough-in inspection required? ❑ Yes ❑ Na� Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
r lt
(You must call the inspedor when ready) Date Ready:
I, ❑}�ICensed contractor ❑ owner hereby request inspection of the above electrical work at:
.bb Address (Street, Box, or Route No.) City Zip Code
07501 UNIVERSITY AVE N FRIDLEY 55432
Section No. Township Name or No. Range No. Fre No. Counry
ANOKA
Occupant Phone No.
MERLE R FORD 786-1185
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Comparry Name) Contractor License No. Master Lic. No. (Plant Eled. Only)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation) �
12467 BOONE AVE S.SAVAGE MN. 55378
Authorized Sig t re (Contractor or Owner Performing Installa[io � Phone No.
�640�
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY