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*03808672*
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 Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by thrs request Enter remarks rn this space and on the back of the white cqoy only.
SAYER'S S�IITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be acceAted without the conect tee:
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. g0
Sign/Outline Ltg. Xfmr.
Alarm/Remot Co trol
Swimming P = I hereby certify that I inspectetl the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
eciallnspection '
Final Datc) _��
Investigative Fee ��Y
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
,� ��—_--.-__�W____��..___—___
OFFICE USE ONIY This request void 18 months from validation date printed in this box.
sso-s67�] � � � �
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JOB AIUMBER #970600
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: 8I 14I g8
1, ❑ icensed contractor ❑ owner hereby request inspection of the above electrical work at:
,'°b "�i�s���t, e°", o� R�A��i�i I NGTON ST NE c�tYFR I DLEY Z�p ��5432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
�cuPJUDY K BITTNER P��No S%.2-1%38
Power Supplier Address
NSP HPLS QE'F'ICE
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 BOONE AVE S. SAVAGE HN. 55378
Authorized Sig re(Contractor or Owner Performing Installation) � � Phone No.
b� � 94 —4?12/890-355
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY