P - 83271RE(IUEST FOR ELECTRICAL INSPECTION `�
6 p r� (� �� Minnesota State Board of Electricity �
o�- L l� 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
', - Phone(612)642-0800 " '
X Home Duplex Apt. Bldg. Other:
Commercial Industrial Farm
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heaf Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the
New
Remod
the white copy only.
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Calculate lnspection Fee - TFiis Inspection Requesi wi!! noi be accepied withoui the correct fee:
Other Fee # Service ntranc ' e Fee # Circuits/F rs Fee
Mobile Home Park Stoll 0 t 200 mps • 0 to 100 Amps •
Street Ltg./Traffic Sig. Above 00 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Oudine Ltg. Xfmr.
75.00
Alarm/Remote Conhol
Swimming Pool
I here6 ceAi rhaf I ins fed Ihe electrical insfollation deuribed herein on the dotes stated
Irrigation.Boom � RougMn Data
Speciallnspect� �
F�� oa =Z�
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in fhis box.
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PLEASE PRINT OR TYPE
Request Dote 9_21-98 Rough-in inspecfion required? ❑ Yes � No Inspeciion Other Than RougMn: �] Ready Now ❑ Will Call
(You must call the inspector when ready� Date Ready:
I, [� licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheet, Box, or Roule No.) Ciy Zip Code
6858 Washington St NE Fridley 55421
Secfion No. Township Name a No. Range No. � Fire No. CounN
occupanr
Cl de Edwards
vaW�, s�,����
NSP North Division
Electrical Conhacfor �Company Name�
(Conhocfor or Owner
Anoka
Phone No.
571-9770
4ddreu
3115 Centre Point Dr Roseville MN 55113
Conhaclw License No. Master Lic. No. IP�ant Elect. Only;
�Conhacfw or Owner Perfo g Installation) _ ti' V(J q1�No.
��7/I/� " 786-
ST BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY