P - 83706, � ��r��C1���� ����� ����� ����� ����� ����� ����� ���� ����
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REQUEST FOR ELECTRICAL INSPECTION �,�€'TME�
Minnesota State Board of Electricity � °i
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 �"°�'�
Home Duplex Apt. Bldg. Other: New Addn i
Commercial Industrial Farm Remod Repair �
IAir Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
IDryer Range Elec. Heat emp. 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
IICalculate In�oection Fee - This Inspection Request will not be accepted withouf the conect tee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee II
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 � O
Sign/Outline Ltg. Xfmr. 15.
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Speciallnspection •
Final � � � Dat9-, _C
Investigative e L
THIS INSTALLATI N A BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
. � � OFFICE USE ONLY This request void 18 months from validation date printed in this box.
I 363-909 � � �3 � � �
�5��� JOB NUMHER �9706000
PLEASE PRINT OR TYPE
Request Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 7� 1%� 9%
I, u licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) Cit Zip Code
00277 RICE CREEK BLV NE F�tIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
KENNETH P PEDERSON 571-2926
Power Supplier Address
NSP MPLS OF'F'ICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
ltA�TER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 800NE AVE B. SAVAGE MN. 55376
Autho � d Signa re (C ctor or Owner Performing Installat�n) Phone No.
� f j
94 471 /890-
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I� EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY -
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