P - 832096���251 � rt
X Home Duplex
Commercial Industrial
x Air Con . Htg. Equip
Dryer Range
"X" above the work covered by
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612) 642-0800
Apt. Bldg. Other: New
Farm Remod
Water Hh. Load Mgmt. Other:
Elec. Heat Temp. Service
requesi. Enter remarks in this space and on the back of the white copy
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Calculate Inspection Fee - This Inspection Request will noi be accepted 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 Am s Above 100 Amps
Transformer/Generator iNS/� �CroR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. S�%c,� �-C 15. 50
01���„/Qomote Conhol /
� Pool
Boom �. .
that I inspecfed the elechical installation dexribed herein on the da
Date
� Investigative Fee � � ( �' I��� ��
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THIS INSTALLATION MAY BE ORDERED dSCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
.. OFFICE USE ONLY This request void 18 months from validation dafe printed in fhis box.
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* 0 6 4 1 2 5 L 4* '7 �� `7'
PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspeclion required2 ❑ Yes �No Inspecfion O�er Than Rough-In: �Ready Now � Will Call
7-1-98 (You musf call the inspec�or when ready� Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheef, Box, or Route No. City Zip Co
7686 Van Buren S�t NE FRidley `�T 55432
Section No. Township Name or No. Range No. Fire No. Couny
Anoka
o�����f
Dan Roufs
Power $upplier
Phone No. 780�326,�
Electrical Conhacror (Company Name) Conhactor �icense No. Master Lic. No. �Plo�t Elect.
Total Electric, Inc. CA02749
Mailing Address (Conhacfor or Owner Performing Insfallation)
1537 9 nd Ln nE Blaine MN 55449
Aufhorized ature (Conhactor or Owner Pe rming In Ilah r Phorre No.
786-8484
B-00 A- 1 6 S7�A7E gOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY