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* 0 3 8 7 4 3 6 9* Phone (612) 642-0800 ����
, Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm )C Remc
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 space and on the back of the white copy only.
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:ulate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Servic trance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall j 0 200 A ps ,`�s L 0 to 100 Amps / O
Street Ltg./Traffic Sig. Ab 0_Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. ���
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Specialln F;nai �*, �� ,
INSTALLATION MAY BE ORDERED
• � � �
DISCZ3FIRECT'ED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request wid 18 months from validation date printed in this box.
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7�'�/
PLEASE PRINT OR TYPE
Request Date � Rough-in inspection required? ❑ Yes �f No Inspection Other Than Rough-In:
11- 2 0- 9 S (You must call ihe inspector when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City
5869 Hackmann Ave Fridley
Section No. Township Name or No. Range No. Fire No. County
Anoka
Occupant Phone No.
Ready Now �Will Call
Zip Code
55432
Kelley Wolf
Power Supplier Address
NSP 3115 Center Pointe Dr,Roseville,MN
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Bassin El
Mailing Address (Contractor or Owner Performing Installation)
1354 McKay Dr, Ham Lake MN 55304
Authorized ignature Contractor or Owner Performing Installa[ionj Phone No.
� �� '�' e � 434-3298
EB-00001A-11 8/95 STATEBOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY