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* 0 3 7 1 6 6 6 9* Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
II Commercial Industrial Farm Remod
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 ITISTALLATIOH
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Addn
Repair
Ca/culate Inspection Fee - This Inspection Request will not be accepted without the correct tee:
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. 15. 50
Alarm/Remote r� � � ��;
Swimming Pool ��� ~ I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rougn-i� Date
}{ Special inspection 1• S� Final � /
Investigative Fee �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLV This request void 18 months from validation date printed in this box.
371-666 � �
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JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Requ�f�a�e17 � 97 Rough-in inspection required? ❑ Yes [�Jo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 10I 1% I 9%
I, �] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
00040 64TH WAY HE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
PAUL C
Power Supplier
MATT;
Address
AN�KA
Phone No.
SA�—
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Installation)
Aut ori � at e( ontractor or wner Per orming Insta ation Phone No.
P' '+
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EB-00001A-11 8 95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY ,