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� * 0 3 7 9 9 1 1 1 �` Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm °5 � �� Remo
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this requesi. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Ins,nection Fee - This Inspection Request will not be accepted withoui the correct fee:
Other Fee # Service Entrance Size Fee � Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Am
���w
�"�a.;�,�'�%" _
Addn
Fee
Transformer/Generator INSPECTOR'S USE ONLV TOTAL 5 O
Sign/Outline Ltg. Xfmr. 15.��
Alarm/Remote Control
Swimming Pool I hereby certify that 1 inspected the electricai installation described herein on the dates stated
Irrigation Boom Rough-In Date
pecial Inspe F��ai s�
Investigative ee '' 2J "[ a
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.
379-911�] s �
�, �-� ���
� JOH NUMBER �i97060Q
PLEASE PRINT OR TYPE
Request D � � Rough-in inspection required? ❑ Yes ❑ N Inspection Other Than Rough-In: ❑
(You must call the inspector when ready) Date Ready:
I, ❑�censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City
01400 MISSISSIPPI ST N FRIDLEY
Section No. Township Name w No. Range No. Fire No. Counry
Occupant Phone No.
THOliAS D STONE
Power Supplier Address
HSP MPLS OFFICE
Electrical Contractor (Comparry Name) Contractor License No.
MASTER ELECTRIC C0. INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
Authorized Signature
or Owner Performing Installation)
EB-00001A-11 8/95 STATE BOARD COPY -§EE INSTRUCTIONS ON BACK OF YELLOW COPY
y Now ❑ Will Call
6/19/98
Zip Code
55432
ANOKA
572-8528
Master Lic. No. (Plant Elect. Ony)
Phone No.