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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 Temp. Service
"X" above ihe work covered by this request. Enter remarks in this s,oace and on the back ot the white cqoy only.
SAVER'S SWITCH IHSTALLATION
Calculate In�oection Fee - This Inspection Request will not be accepted without the conect 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
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 Boo . �• � Raigh-In Date
Special inspection ` � �
Final
Investigative Fee �
THIS INSTALLATION MAY BE ORDERED DI CONNEGTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request wid 78 months from vatida[ion date pNnted in this box.
392-327�3] ���
PLEASE PRINT OR TYPE JOB NUMBER #9�06@00
Req i ia� 3�' 9g Rough-in inspection required? ❑ Yes [�plo Inspection Other Than Rough-In: ❑_ Ready Now ❑ Will Call
(You must call the inspector when ready) ji Date Ready: 1S
I, �] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
00516 54TH AVE NE FRIDLEY 55421
Section No. Township Name or No. Range No. Fire No. County
AHOKA
Occupant phone No.
Power Supplier Address
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mai ing dress ntrac or or ner er orming nstaflatron '
Au atu o n Pe rtn I f .� Phone No.
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EB-00001q-11 8/g5 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY 0- 3555