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P - 83139616-227 � X Home Comrr g Air Cc Dryer "X" abow 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. iiiiiiiiiliiiilii�iii�iiiiiiiiiiiiiiii� • '�`� * 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.