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* 0 3 7 9 8 5 8 4�` Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: S� SC New
Commercial Industrial Farm Remo
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this request, Enter remarks in fhis space and on the back of the white copy oNy.
SAVER'S SWITCH INSTALLATION
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Addn
Repair
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee +s Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sireet Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL ,$ (
Sign/Outline Ltg. Xfmr. 15. �
Alarm/Remote Control
Swimm
THI
379-858�
� I hereby certify that I inspected the electrical installation described herein on the dates stated
Rough-In Date
I. 0 inal �Q- D
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BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS�_
OFFICE USE ONLY This request void 18 moMhs from validation date printed in this box.
15 �� �
�����y JOB NUMBER �97060�
PLEASE PRINT OR TYPE
Request Da� � 19 � g8 Rough-in inspection required? ❑ Yes ❑ Ndx Inspection Other Than Rough-In: ❑ 1�ady Now ❑ Will Call
(You must call the inspector when ready) �ate Ready: 6/ 19 / 98
I, ❑xicensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
00209 RICE CREEK BLV N FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant
Phone No.
LOUIS F' KAHHK
Power Supplier Address
NSP MPLS OF'FICE
Electrical Contractor (Company Name) Contractor License No.
MASTBR ELECTRIC CO.,IHC. CA01192
Mailing Address (Con[ractor or Owner Performing Installa[ion) . ��
12467 BOOHE AVE S. SAVAGE liN. 55378
Authorized Signature tor or Owner Performing Installation) "
r
EB-OOOOtA-11 8/95 STATE BOARD COPY - SEE INSTR CTION ON BACK OF YELLOW COPY
571-2108
Master Lic. No. (Plant Elect. Only)
Phone No.
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