P - 83139616-227 �
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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 -
Phone (612) 642-0800 `'�'
Other: x New Addn
Farm
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on
copy
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
$treet Ltg./Traffic Sig. Above 200 Am s Above 100 Ai
Transformer/Generator INSPECTOR'S USE ONLY TOT,
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Fee
15.50
I hereb certi that I ins ed the elechical installafion described herein on the dates staled
Irrigation Boom Rough-In Dure
Special Inspecti '� j'~
� Investigative Fee �'� `� � [ ,1f-/— �� J
THIS INSTALLATION MAY B�_ORDERED DISCONNECTED IF NAT CQINPLETEU 1KITHIN.18MQeITHS. _
OFFICE USE ONLY This requesf void 1 S months Irom validafion dafe printed in this box.
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* 0 6 1 6 2 2 ? 5* l�Q�
PLEASE PRINT OR TYPE
Requesf Dafe Rouglfin inspecfion required? ❑ Yes � No Inspecfion Other Than RougMn: � Ready Now ❑ Will Cal)
4-1-98 (you musf call Ilie inspecfor when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
lob Addreu (Street, Box, or Roule No.) Ciy Zip Code
1385 Skywood Ln Fridley 55421
Section No. Township Name or No. Range No. Fire No. County
Anoka
Occupant
John Pollard
Power Suoolier
Elechical Conhacfor (Company Name)
Total Electric InC.
Mailing Address �Conhactor or Owner Performing Installafion)
1537,�2nd Ln NE Blaine MN 55449
Aufhoriz gnature �Conhacfor or Owner �rforming In II ti - � r , ..�
� t.� I . ..,, 7
BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
Phone No.
ihacfor License No.
CA02749
571-6755
Masfer Lic. No.