P - 83609����II (IIII IIIII (IIII II�II IIIII III�I (IIII IIII IIII
*03923729*
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. X Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this request Enter iemarks in this space and on the back of the white copy only.
SAVER'S SWITCH ITISTALLATION
Calcu/ate Inspection Fee - This Inspection Request will not be accepted wifhout the conect fee:
Other Fee +s 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. Y�. 50
Alarm/Remot tr I
Swimming Po I hereby certify that I inspected the electrical installatbn described herein on the dates stated
Irrigation Boom Rough-In Da�e
X Speciallnspection 1 . 50
Final - Dat, ! p
Investigative Fee L j
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.
392-372�] � ��, �
�a �
JOB NUMBER #9ffi06000
PLEASE PRINT OR TYPE
Reque�t iat� �0 � 98 Rough-in inspection required? ❑ Yes ❑�o Inspedion Other Than Rough-In: �( Ready Now ❑ Will Call
(YOU must call the inspec[or when ready) �ate Fteady: I 1/ 30 / 98
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
�7404 WEST CIR NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
AHOKA
Occupant Phone No.
DAH L LAMBERT 717-2319
Power Supplier Address
N5P MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Ony)
MASTER ELECTRIL CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation) .
12467 B�ONE AVE S. BAVAGE MN. 55378
Authorized Signature (Contra or Owner Performing Installation) Phone No.
941 4712/ 9 -35 5
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY