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X Home Duplex
Commercial Industri
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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 "�'
Apt. Bldg. Other: New Addn
Farm Remod Re air
ip. Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
�y ►his request. Enter remarks in this spoce and on the back of the white copy only.
Calculate Inspection fee - fhis Inspection Request will not be accepted wifhout 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 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. 15. 50
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins the eleckical installafion desc�ibed herein on the dales stated
Irrigation Boom Ro�M� Dare
Speciallnspecti •
Investigative Fee F��al D �—!
/
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 1& months 6om validation date printed in this box.
I�HI�III��I�I�I��III�I�I��I�� �� � !'/s'�j�
* 0 6 6 8 8 8 9 9* �`��O
PLEASE PRINT OR TYPE
Requesl Dafe Rough-in inspection required? ❑ Yes
7�,Z 7�98 � No Inspecfion Other Than Rouglfln: � Ready Now ❑ Will Call .
(You musf call the inspeclor when ready� Date Ready: .
I, [�licensed conhactor ❑ ow�er hereby request inspection of the above elechical work at:
Job Address (Street, Box, or Roufe No.) City Zip Code
5908 5th St NE Fridley 55432
Seclion No. Township Name w No. Range No. Fire No. Counly
Occupant
Bev Hibbard
Power Suodier
Phone No.
571-1106
Elechical Confracfor (Company Name) Contracror License No. Master Lic.
Total Electric Inc. CA02749
Moiling Addreu (Conhacfor or Owner Performirg Inslallafion)
1537 92nd Ln NE Blaine MN 55449 ,� �j '
Aufhoriz i ature �Conhacfw or Owner rforming Insfallafion) ^ � Phone No.
� 786
EBO 1 A-11 8/96 STATE BOARD COPY - SEE INSTRUCiIONS ON BACK OF YELLOW COPY
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