P - 84097Ill�il IIIII IIIII IIIII IIIII Iilll IIIiI IIIiI 1111 IIII
*03716586*
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
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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 ot the white copy only.
SAVER'S SWITCH ITISTALLATIOH
Calculate Inspection Fee - This Inspection 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 ONLV TOTA4 5. 50
Sign/Outline Ltg. Xfmr.
1
Alarm/Remo t� ,..,
Swimming P � �1 I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In �ate
Speciallnspection '
Investigative Fee F��a� ���--�------_-_ oat� 2¢ �v
0
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.
371-658 [� � S�
���/T��/ JOB NUMHER #970600Q1
PLEASE PRINT OR TYPE
Requ t 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: 1 0/ 1% I 9%
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�o��s��treet, Box, w_R4u1qN�} NGTON ST NE �� I DLEY Z���432
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Section No. Township Name or No. Range No. Fire No. County
AH�KA
Occupant Phone No.
DARWIN K KLOCKERS 571-7623
Power Supplier Address
NSP MPLS OF'FICE
� Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTEB ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOOHE AVE S. SAVAGE liH. 55378
Aut ri S� ature (Contractor or Owner Performing Installation) Phone No.
"►�, , 941 4712/890-3555
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� EB-0000 - 8/95 STATE BOARD COPY - SEE INSTRU I�F1S BACK OF YELLOW COPY
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