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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:
Commercial Industrial Farm
Air Cond. Htg. Equip. Water Htr. L�
Dryer Range Elec. Heat T
"X" above the work covered by ihis request. Enter rem�
New
Remod
Mgmt. ��b��brm damage to mast
Service
in this space and on ►he back of the white 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 2S . �� 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Am
Transformer/Generator INSPECTOR'S USE ONLY �,/j� TOTA
Sign/Outline Ltg. Xfmr. //�-}% �1�
Alarm/Remote Conkol �� _
Swimming Pool __ _ � hereby certify that I inspected the elechical installation described herein on the dates
Fee
.50
Investigative Fee ����� '%= 2yS� 7'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This requesf void 18 months from validafion date prinfed in fhis box.
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* � 4 � 5 3 � 5 4* PLEASE PRINT OR TYPE �� �
Request Dafe Rou h-in ins ection re uired$ ❑ Yes
g p q � No Inspection Other Than Rough-In: �] Ready Now ❑ Will Call
7/ 2 3/ g 7 (You musf call the inspector when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
1ob Address (Sheet, Box, or Route No.) City Zip Code
211 Stoneybrook Way NE �'ric�.'��� 55432
Section No. Township Name or No. Range No. Fire No. County
Anoka
Occupanf Phone No.
Hein, Bruce 571-3534
Power Supplier Address
NSP 3115 Centre Point Dr, Roseville 55113
Elechical Conhactor (Company Name) Conhactor License No. Master Lic. No. �Plant Elect. Only)
Total Electric Inc CA02749
Mailing Address (Conhactor or Owner Performing Installafion) _. .
1537 92nd Ln NE Blaine MN 55449
Authorized Siy�lure (Conhactor or Owner Performinalnstallation) .� Q' Phone No.