P - 83724� REQUEST FOR ELECTRICAL WSPECTION ��;�
;I I�I�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 1ng21eUni eSsty A earRmf SI 128cSt. Paul, MN 55104 ��. �
* 0 3 6 3 9 3 2 5* Phone (612) 642-0800 "`'��
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat emp. 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
ulate Inspection Fee - This Inspection Request will not be accepted without the correcf 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 ONLV T�T�5. 00
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
— Speciallnspedio �ate
Final � �{��_ _^Z � X
Investigative Fee N �'
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.
363-932�] �
2 ��Ba
�Jr�t�� JOB HUMBER #k9706000
PLEASE PRINT OR TYPE
Request'�a� 1%/ 9% Rough-in inspection required? ❑ Yes �i�lo Inspection Other Than Rough-ln: [
(You must call the inspector when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No. Cit
�5610 W BA�ARIAN PAS F�?IDLEY
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
JEAN G ROSEBROCK
Power Supplier Address
NSP MP[.S OF'FICE
Electrical Contractor (Company Name) Contractor License No.
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAVAGE ![N. 55378
Ready Now ❑ Will Call
7/17/97
Zip Code
55432
571-8251
Master Lic. No. (Plant Elect. Only)
Autho � Signatu (Contr to or Owner P rforming Installation) Phone No.
941 4712/890-3555
=6-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUC I ON BACK OF YELLOW COPY