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Home Duplex AF
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Other: New
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Htr. 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 INSTALLATION
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Addn
;alculate 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. Xfmr. ZS. rJ0
Alarm/Remote Control
Swimming Poo � r �'M I hereby certify that I inspected ihe electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
}{ Speciallnspection 1 . 50 Da �j
Final _
Investigative Fee �
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.
371-639 � l� ; ��
/P'�c����J� JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Reque�t�aaJe 1'� � 137 Rough-in inspection required? ❑ Yes �lo Inspection Other Than Rough-In: [X Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 10 � 17 � 9'7
I, �] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route NoJ �,� Ciry Zip Code
01287 ONONDAGA ST NE � FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
MARLYS ANN
Power Supplier
NSP
Electrical Contractor (Company Name)
Mailing Address (Contractor or Owner Performing
(Contractor or Owner
ANOKA
Phone No.
GRAHAM 784-4965
Address
MPLS OFFICE
Contractor License No.
8/95 STAT�A,���O�V -rSfE INSTRUCTIONS ON BACK OF YELLOW COPY
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Master Lic. No. (Plant Elect. Only)
Phone No.