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*03798071*
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. Bidg. Other: � a �� New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Efec. Heat Temp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Requesi 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 15. �
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swil7lflllllg PO ' I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boo c Rough-In Date
peciallnspection '
Fina! / _ G+
Investigative Fee � f� - T
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.
379-807�] � �
/5�
n ,� �� �1 JOB HUMBER �t970600
PLEASE PRINT OR TYPE �� ' �/
Request Da Rough-in inspection required? ❑ Yes ❑ N Inspection Other Than Rough-In: ❑ dy Now ❑ Will Call
(You must call the inspector when ready) Date Ready: G� 19 � 98
1, ❑ icensed contractor ❑ owner hereby request inspection of the above electrical work at:
JobAc�fe�s�$tr�,Box,orR�er�AVARIAN CT c"YFRIDLEY Z�P�°�5432
101 b
Section No. Township Name or No. Range No. Fire No. County gNOKA
Occupant Phone No.
BARHARA J BLOCK 574-0B02
Power Supplier Address
NSP MPLS OFRICE
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 BOOME AVE S.SAVAGE MN. 55378
Authorized Signatu ractor or Owner Performing Installation) A� Phone No.
'� � Y 94 -4712/890-355
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OP YELLOW COPY