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P - 84111I�I�IEIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII R8 Q UESe SFORve.LRm. SR1C8, StN aPEMNION04 �����' Minnesota State Board of Electricity '� '* 0 3 7 1 6 5 4 5* Phone (612) 642-0800 �`�_� 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 the work covered by this request. Enter remarks in this space and on the back of the white copy only. SAVER'S SWITCH IHSTALLATION �alculate Ins,nection Fee - This Inspection Request will not be accepted without 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 Amps Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY TOTLIL Sign/Outline Ltg. Xfmr. 15. 50 Alarm/Remote ontr I Swimming Po I hereby certify that I inspected the electricai installation described herein on the dates stated Irrigation Boom Rougn-in Date Special inspection • Final Date/ � �-�^� Investigative Fee � 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. 371-654 [� � �, � �` ���`�/ JOB NUMBER #9706000 PLEASE PRINT OR TYPE Requ�t(�a�21'7 � 9'� Rough-in inspection required? ❑ Yes �{Jo Inspection Other Than Rough-In: [� Ready Now ❑ Will Call (You must call the inspector when ready) Date Ready: ,i, 0I 1% I 9% I, }J licensed contractor ❑ owner hereby request inspection of the above electrical work at: Job Address (Street, Box, or Route No.) City Zip Code 0Q1596 63RD AVE HE FRIDLEY 55432 Section No. Township Name or No. Range No. Fire No. County I ANOKA Occupant Phone No. KEYIN B JOHNSON 574-2019 Power Supplier Address I NSP MPLS OF'FICE 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) Aut S' ature (Contractor or Owner Performing Installation) Phone No. :. e � /� �! (. =B-00 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY