P - 82080.!
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REQUEST FOR ELECTRICAL INSPECTION �" E
Minnesota State Board of Electricity �
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 _
(651) 642-0800 www.e/ectricity.state.mn.us r "
?C Home Duplex Apt. Bltlg. Other: New Atldn
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 ot the wnite copy onry.
Ca/culate Inspecti<
Dther Installations
Mobile Home Park Stall
Street Ltg. ! Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Controt
Swimmin Pool
Fee - This
NSP SAVER'S SWITGH
not
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
�ted without the correct fee.
# Circuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
TOTA��,
9 I hereb certi(y that I inspected the electrical installation described herei� on the dates stated:
Irrigation Boo Rough In Date
Special Inspec
F;� Date
Investigative Fee "Z - 2 z' "d �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
..... .............. w.......,........ �............. _..........: ..... � ..........,..... _ , _. m.....,...... .......
OFFICE USE ONLY This request void 18 moMhs from validation date printed in this box.
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PLEASE PRINT OR T/PE
Request Date Rough-In inspection required? ❑ Yes � t(d Inspection Other Than Rough-In: eady Now � Will Call
��4�� You must call the inspector when ready! Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zp Code:
587 BENNETT DR NE FRIDLEY 56432
Section No. Township Name or No. Range No. Fire No. Counry
----- --- -°--------° �.......... I'YIVR�
Occupant Phone No.
JQHN3GN KENNET1i V ----
Power Supplier ►* � Address
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Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor, Company or Owner Performing Installation)
23U0 TERRITORIAL R�AD , SAINT PAUL, MN 561'14
Authorized Signature (Contractor, Company or Owner Pertorming InstallaHon) Phone Number
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EB-OOOQ1A-12 5(7999 STATE BOAHD COPY SEE INSTRUCTIONS ON BACK OF YELLOW CAPY