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Minnesota State Board of Electricity �
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* 0 3 6 3 8 6 8 1* Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white cqoy only.
I SAVER'S SWITCH INSTALLATION
Calculate Inspeciion Fee - This Inspection Request will not be accepied without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
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 TOTA�S. 00
Sign/Outline Ltg. Xfmr.
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
Special Inspection
Final e
Investigative Fee —/5—�
THIS INSTALLATION M Y E ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
363-868�] � ,�� �
��'�� JOH NU?fBER �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: %� 1%� 9%
I, jJ licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�007�5�ytreet,Box,�UHIV�RSITY AVE NE F�tIDLEY Z�P55432
Section No. Township Name or No. Range No. Fire No. County
AHOKA
Occupant Phone No.
EMIL P LOREN2 7B6-9762
Power Supplier � Address
NSP MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 800NE AVE S. SAVAGE KN. 55378
Autho � ed Signat e(Contr c r or Owner Performing Installati ti ' Phone No.
� � :F V � 941 4712/890-3555
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY �