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Minnesota State Board of Electncity �
/ * * Phone (612) 642-0800 �`'�'�
Q3716529
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 emp. Service
' above the work covered by this request. Enter remarks in this �oace and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection 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 TOTAL
Sign/Outline Ltg. Xfmr. 15. 50
Alarm/Remote Control
Swimming Po �% ` I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Special Inspection
Final r D �2��
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.
371-652 [� � 5-�
� � � �� JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Reque�st,Qa�1,7 / 9,7 Rough-in inspection required? ❑ Yes R➢lo Inspection Other Than Rough-In: G6 Ready Now ❑ Will Call
i ia �t �i
(You must call the inspector when ready) Date Ready: 1� I 1% I J%
I, �,] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
QJ0611 67TH AVE NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
Power Supplier � Address
ANOKA
Phone No.
Electrical Contractor (Company Name) I Contractor License No. I Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner
Phone No.
8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY