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RE(�UEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone(612)642-0800
Other: New Addn
Industrial Farm
Htg. Equip. Water Htr. Load Mgmt. Ofher:
Range Elec. Heat Temp. Service
overed by this request. En►er remarks in this space and on
Calculate Inspection Fee - This Inspection Request will not be acc�
Other Fee # Service Entrance Size
Mobile Home Park Stall 0 to 200 Amps
$treet Ltg./Traffic $ig. Above 200 Am
Transformer/Generator INSPEC70R�S USE ONLY
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I herebvi certifv that I insoected the
without the correct fee:
Fee # Circuits
copy only.
Above 100 Amp:
TOTAL
described herein on the dates sfated
Dafe
Fee
Special Inspec�Alinv v t3
Investi9ative fee Final ���/__ ��
�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MO S.
OFFICE USE ONLY This reques� void 18 monfhs from validatior date printed in this box.
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* 0 7 3 7 9 1 7 5* �� c��
PLEASE PRINT OR TYPE
Requesf Date Rough-in inspecfion required? ❑ Yes
3-16-99 � No Inspection Ofher Than RougMn: �] Ready Now ❑ Will Call
�You must call the inspector when ready) Date Ready:
I, � licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Roufe No.) Cify Zi Code
P
6530 Fridley St Fridley 55432
Secfion No. Township Name or No. Range No. Fire No. County
Occupanf
Floyd Kummala
Power $uoolier
Elecfrical Conhactor (Company Name)
Total Electric Inc.
Mailing Address �Conhacfor or Owner Performing Insfallafion)
10760 kato St NE S ite 1 B1
Authorized Signa Conhacfor or Owner Perfor �Insfallation)
�L��- �
EB-0OOOlA-1 /96 STATE BOARD COPY - SEE INS
Phone No.
CA02749
N 55449
571-7296
Masfer Lic. No. (Planf Elect. �
Phone No.
786-8484
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