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� *03869799*
REGIUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity �� °r
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �s. -. �
Phone (612) 642-0800 �`'�"yY
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in ihis space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be acCepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile 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. m . 15. �0
Alarm/Remote C
Swimming Pooi 1 hereby certify that I inspected the electrical installation tlescribed herein on the dates stated
Irrigation Boom Rough-In Date
pecial Inspection �� Date
Investigative Fee `/- 2�' Y
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This recKiest wid 18 months from validation date printed in this box.
386-979� � �S�
S�/�"
JOH HUMBER #97�600
PLEASE PRINT OR TYPE
Request Dat� �� 4� 98 Rough-in inspection required? ❑ Yes ❑ Nq� Inspection Other Than Rough-In: ❑ Bqady Now ❑ Will Call
(YOU must call the inspecta when ready) � Date Ready: 1S
I, ❑�censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
00582 HUGO ST NE FRIDLEY 55432
Section No. Township Name w No. Range No. Fire No. County
ANOKA
Occupant Phone No.
T O HY J
Power Supplier Address
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Onty)
Mailing ress ( Mractor or wner ormmg Insta lat' )
Author¢e igna[ure ( a or or Owner or uig I a' ;* /� ^ Phone No.
�� lJ �)
EB-OOOOtA-11 8/95 STA7E BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY