P - 83488REQUEST FOR ELECTRICAL INSPECTION
� 4 q�� C C Minnesota State Board of Electricity
1 V V 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
X Home Duplex Apt. Bidg. Other: New
Commercial Indushial Farm Remod
X Air Con Htg. Equip. Water Hfr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this requesi. Enter remarks in this space and on the back of the white copy
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Lig./Traffic Sig. Above 200 Am s Above 100 Ai
Transformer/Generator INSPECTOR'S USE ONLY TOT,
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I herebvi certifv thaf I insnecfed fhe elecfrical insfallafion described herein on the dafE
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Fee
15.50
Imestigative Fee � ,�-,:�-" (f
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
I�e' II III II II OFFICE USE ONLY This requesf void 18 months from validation date printed in fhis box.
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PLEASE PRINT OR TYPE
Requesf Dafe Rou h-in ins cfion r uired2 p g OCReady Now ❑ Will Call
9 Pe eq ❑ Yes [�No Ins ecfion Other Than Rou Mrin:
7-6-98 �You musi call fhe 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.� City Zip Code
728 58th Ave NE Fridley 55432
Secfion No. Township Name or No. Range No. fire No. County
Occupant Phone No.
Steve Linders 572-9348
Elechical Contracfor (Company Name) Conhacfor License No.
Total Electric Inc CA02 749
Mailing Address (Confracfor or Owner Performing Insfallation)
1537 92nd Ln NE Blaine MN 55449
Aufhori SignaNre �Conhacror or Owner P ming Insf lati �
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E lA-I 1 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF
Phone
Lic. No. (Plani Elecf.