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Minnesota State Board of Electnaty �
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* 0 3 7 1 6 4 8 7* Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. X Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATIOH
�alculate Inspection Fee - This Inspection Request will not be accepted without ihe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobiie 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. 1S. 50
Alarm/Remote Control
Swimming Pool ('b "^ I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom i t� "' Rou9n-i� Date
K Special Inspection , '
Final Dat
Investigative Fee �� � i ^ �
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.
371-648
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JOB NUMHER #9706000
PLEASE PRINT OR TYPE
Requ�TAaye17 � 97 Rough-in inspection required? ❑ Yes [klVo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
YJ
(You must call the inspector when ready) Date Ready: 10 � 17I 97
I, �] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
07518 HAYES ST HE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
PAUL J
Power Supplier
Electrical Contractor (Company Name)
Mailing Address (Contractor or Owner Performing
8/95
ANOKA
Phone No.
HENRICH 783-9925
Address
� OF'F'ICE
Contractor License No. Master Lic. No. (Plant Elect. Only)
or vwner rerrorming ins[aua[ion�
`,� .5''�.
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW �
Phone No.