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P - 82367I q B.t..... E. �'O I 5-485 []4 REQUEST FOR ELECTRICAL INSPECTION Minnesota State Board of Electricity _ � � 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 =_ _ (651) 642-0800 www.electricity.sfate.mn.us Home Duplex Apt. Bldg. Other: New Addn Commercial Industrial Farm Remod Repair Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other: Dryer Range Elect. Heat Temp. Service X" above the work covered by this request. Enter remarks in this space and on the back of the white copy on/y. N5P SAVER'3 SWITCN Calculate lnspection Fee - This nstallations Fee # Mobile Home Park Stall Street Ltg. / Traffic Sig. Transformer/Generator Sign / Outline Ltg. Xfmr. Alarm/Remote Control I will not be accented without the correct fee. 0 to 200 Amps Above 200 Amps INSPECTOR'S USE ONLY I electrical # Circuits / Feeders Fee 0 to 100 Amps Above 100 Amps TO�I�_ 50 allation described herein on the dates stated: Investigative Fee F�� � l� I�� ��"�� I THIS INSTALLATION MAY BE ORDERED ONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. .,......�.,,...;�,.,ss•�.�...�•,.•..,���..•...�� ��•,.,.,...�•,.•�••�•...�..•..a..•,.•..•..•y,.•..•..•..�.•�•....�..,.......•....e..•...,......... I II�III,1III IIIII IIIII IIIII III II�I,tII (II) OFFlCE USE ONLY This requeat void 18 moMhs from validation date printed in this box. N ii �a � * 1 0 1 5 4 4* o�s� � � PLEASE PRINT OR TYPE Request Date Rough-In inspection required? ❑ Yes ❑ o Inspection Other Than Rough-In: Ready Now ❑ Will Call ��_� You must call the inspedor when ready! Date Ready: I, [�4icensed contractor ❑'company ❑ owner hereby request inspection of the above electrical work at: Job Address (Street, Box, or Route No.) City Z�P �e� 700 67TH AVE NE FRfDLEY 55432 Section No. Township Name or No. Range No. Fire No. Counaty�� ' AiR/M Occupant Phone No. RiCKENBr�iCH JOSEPH S : Power SuppliP! � Address �� Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Onry) Hurrr E�c-r��e coR�ano� cn aoes� Mailing Address (Contractor, Company or Owner Performing Installation) 230d TERRITORU�. ROAD , E�AJNT PAUL, MI+1 561 i 4 Authorized Signature (Contractor, Company or Owner Pertorming Installation) Phone Number � \ �� PR� � EB-00001A-12 5/1999 STATE BOARD COPV SEE INSTRUCTIONS ON BACK OF YELLOW COPY