1652 Covington LaneCITY OP EAGAN
3795 Pilot Kwob Road _ Eegan, MN S5122
..
BUILDING PERMIT
Reteipt # _-l t ' t
Site Add?ess 1657 Covington Lane Erect }Q Occupancy R,-?
Lot 14 Block I_ Sec/Subjohnn9 Cake Ridge lSXlter Cj Zoning T" -1
Porcel # 70 39800 140 nl Repalr ? Fire Zone NA
Enlarge Q Type of Const. V
W Warne (:hsirlpfi h'?4p11ndA Shu r_a Move
? ,'? 5tories
Z Addmss 1652 IIovin&ton Lane Demolish ? Length16,
?
Ci phone 457_21;24 Grnde p Depth9A_Sq. Ft.
°C Nome [?r,rnpr Approvols Fees
o
/\ddress Assessment Permit 1.7Sn
Cit p?? Water & Sew. Surcherge 51
Police Plon check
Name Fire SAC
F
Address Eng. Water Conn.
<W Ci phane Plortner Woter Meter
CouncVl Rood Unit
1 hereby acknowledge that I hove reed this opplicorion and stote thot Bldg. Off,
the inlormotion is wrrect and ogree to comply wlth all upplicable APC Totel $1 ?-??
State of Minnesota Stotutes pnd City of Eagan Ordirwnces.
Signaturc of Permittee I
A Buildin Permit is issued to: °nar1P.8 S:lults on the e
g xpress condition tMo
oll work shell be done in accordance with all opplicable 5tate of Mfnnesofa Stafutes ond City of Eo4en Ordinonces.
i
8uildinfl Offlciol - ?.t--'•,??-" r ,
Psrmit No. Permit Holder Miac. Permit No. Holder
Plumbing
H.V.A.C.
Well
Water
Disp.
Sewer
Ekctric
Inspeetion Date Insp. Other
Footings
FoundBtion
Framing
Rough Pibg.
Rouen HVAC
Insulation
Final Plby.
Final HVAC
Final ?
Water Describe Location:
Well
Sewer
Pr. Disp.
CITY OF EAGAN
' 3795 Ppof Knob Raad Eague, MN 55122 '
PHONE: 454-8100
BUILDING PERMIT Receipt #
To bo wed for Est . Yolue 'Date 19
Site I\ddress -- Erect 0 Occupuncy
Lot Block $eC/$ub. - >? Nlter ? Zoninp
porcel # Repolr p Fire Zona
Enlarge ? Type of Const.
ac
w Name
""' ='"ti"'
-- Move ?
# Stories
; Address Demolish ? Length
t?
e;r„ vf,,,„. Grode ?
Depth Sq. Ft.
a Name Approvols feea
0
u? Address
Assessment
Perrnit
~ Ci Phone Water 8? Sew. Surcherge
? Police Plon check
W Nome Fire SAC
x? Address Enp. Woter Conn.
t W Ci phane Plonner Woter Merer
Council Road Unit
1 hereby ucknowledge thpt I hove reod this applicotion ond stote thot 81dg. Off.
the inlormotion is correct und ugree to comply with a!I upplicoble
Stote of Minnesoto Statures and City of Eogan Ordinonces. APC Total
$ipnoture of Permittee
A Building Permit is issued to: on the express tondition thnt
oll work sholl be done in accordence with all applicable State of Minnesoro Statutes and City of Eayan Qrdirances.
Building Offlcial
Parmit No. Permit Holthr Misc. Permit No. Holder
Plum6ing
H.V.A.C.
Ws11
Water
DisP.
Sewer ?
Electric
Inapection Date Insp. Other
Footings •?}S' ?
Foundation ?-? - ?
Freminy
Rough Plbp.
Rough HVA
Insulation
Final Plbg.
Final HVAC
Final
Weter ??ibe Location:
11Y4a11
Sewsr ?
Pr. Ditp.
• cirY oF Fr?G?N
3745 Pllet Knob Rood Eogan, MN 55122 N2 5678
PHONE: 454-8100
BUILDING PERMIT Receipt #
To bs apd For Fst. Value Date 19
Site Addreas - - - - - - =: i L.i: • Erect ? Occupancy
Lot Blxk Sec/Sub. Jornr-., Alrer ? Zoning
parcel # - ? Repnir ? Fire Zone
E
l T
of Con
t
arge ?
n ype
s
.
oWc Nome Move Q # Stories
3 Address •?;' ,. -s ? 1C, ?. tik. Demolish ? Front ft.
0 Ci ?? -- r _ 7
•
Grode ?
Depth ft.
°C
0 Name APProvals Fees
?? Address
?- r;w
Name _
Address
1 hereby acknowledge that I hove reod this applitation and state that
the informution is correct ond agree to oomply with all applicable
State of Minnesoto Statutes ond City of Eogun Ordinances.
Assessment -
Water & Sew.
Police
Fire
Erg.
Planner
Council
Bldg. Off. •i?'* / APC
Permit
Surchorge Plan check
SAC
Water Conn. :
Water Meter
- nn
Total 11 -, 5 F? _ 7 •
Signature of Permittee I
A Building Permit is issued to: r? 'c `-'` '"= on the express condition that
oll work sholl be done in nccordance with oll applicable Stote of Minnesota Statutes ond City of Eagan Ordinances.
Buildiny Offtcial
PomR # OaM Isa/ ? ?Y«wlltM
Plumbing Q 7
Mechanical 95 (p b - G
>1 - .
INSPECTIONS I
! DATE INSP. Rouph-In Finol
Footinqs Date Inap. Date Irtsp.
Foundation Plumbinfl
Frame/ins. Mechanicol '
Fincl
Remarks:??
, cirY oF EAcAN
' 3795 Pilot Knob Road
No. , E09an, Minnesote 53122
Ptione: 454-8100
PERMIT
,.
Dote: 27,
r' _?) Y!
5ite Addreu: COV_ .
Lot Block ?- 5ub/Sec. J?. C?'•P'd
Name ?? ?omp80F1
.
I Address r? 'rnns; .rt:ss t'oad
CirY ?' -meturf?c1 ,' . Phone:
Name ?-?izel ?1b.ft Ifeatin-
.
g Address 'r, YPImebeC DI`iVe
?
City ''rl Phone:
This Permit is issued on the express condition thot all work shall be
Minnesoto Stotutes and City of Eagan Ordinonces.
INSPECTOR NOTIFICATION
REQUIRED BY LAW
FOR ALL INSPECTIONS
Receipt No.:
Single I
Residential
Multi Res., Comm./Ind. I
New/Alter./Repoir. Cost of Installotion
Permif Fee
Surcharge
Totol . , ?
done in occordance with all oppliaoble Stnte of
Building Officiol
CITY OF EAGAN
3795 Pilot Knob Rood
No Eagan, Minwe:ota 55122 INSPECTOR NOTIFICATION
Phome: 454-6100 REQUIRED BY LAW
i3entPERMIT FOR ALL INSPECTIONS
Date: Receipt No.: Single I
Site Address: 11J2 upVi-"l' 101: _ Residentiol
Lot - Block Sub/Sec.
Name L"'ria Tr1Can?r?JZ1
.
a /lddress HC3nk-i~lt'
City );tj nne .0*,1 - Phone:
Nome
.
?
? Address ?7 Chieg;c
? City 1 i; _, Phone: _ r
This Permit is issued on the express tondition thar all work sholl be
Minnesota Statutes and City of Ea9an Ordinances.
? i._.
New/Alter./Repoir
Cost of Insfallation
Permit Fee
Surcharge
Total
done in accordance with all applfcable State of
Buildirg Officiol
CITY OF EAGAN Remarks
Addition JQ_Hb?' CAKE RIAACF 119DITTCIN Lot 14 Rlk .3 Parcel 10 39800 140 01
owner-<l;U tf, ; tti- ` 111,.?i- `*tit111 street 1652 Covington L.are state?E gan, MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF,
STREET RESTOR,
GRADING
SAN SEW TRIfNK 1975 323.14 . 21.54 is
* SEWER LATERAL -
WATERMAIN
* WATER LATEAAL
WATER AREA
RM EW TR
STO S K
* STORM SEW LAT 1981
CURB 8i GUTTER
SIDEWALK
STREET LIGHT
R 185.00 18455 418180
WATER CONN. 1 305.00 it, r?
BUILDING PER, ir
SAC
PARK
RESIDENTIAL
BUILDING PERMIT APPLICATION
1 f G1 -?-? CITY OF EAGAN
? < < O 3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Constructlon Reuuirements
• 3 registe2d site surveys showing sq. fl. of lot, sq. ft of house; and all rooted areas
(20% manimum lot coverage allowed)
• 2 copies of plan showing beam & window saes; poured found design, etc.)
. i sel of Energy Calculations
• 3 copies of Tree Presenation Plan R IM platled aRer 711I93
. Rim Joist Detatl Ophons selection sheet (bldgs wilh 3 or less uniGa)
DATE / / 2 ,? / D Z
SITE ADDRESS < <O S Z
TYPE OF
APPLICANT
_'!? S14 --I ?_11
RemodellReoair Reouiremenls
. 2 copies of plan
• 1 set of Energy Cakulatiom for heated addi6ons
• 1 sile survey (or extarlor addilions & decks
• Indicate N home served by septic system for additions
VALUATION
R e Y. of o \j -p- f l eti
C? e a-?IF L.3 ?', 5 ( e- N-
MULTI-FAMILY BLDG _Y QN
_ FIREPLACE(S) _ 0 _ 1 _ 2
STREET ADDRESS ?(oS Z C o v'hS-I-e? L.a we
TELEPHONE # 0 1**2?1 CELL PHONE #
(o`d-7 -540-1
PROPERTYOWNER Cleb4'_f L1DL' S 1e'V
CITY ? 5``"' STATE ?"iN ZIP SSrzL
?jvf-2tS -4401 FAX# ?-_
TELEPHONE# S? ? A?'K
------------------------------°------------------°-------------------------------
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Cate9orY - MINNLSOTA RiJLES 7670 CATr;GORY 1 MINNESOTA RUI.1;6 7672
(d submission type) • Residential Ventilation Category 1 Worksheet Su6mitted • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Contractor: ___
Plumbing system includes:
Mechanical Contractor:
Mcchanical system includes:
Sewer/Water Contractor.
air condiuo,?ing
Heat Recovery System
P'ce: .?',90.00
Phone #
p I? (? ?r. Il d C? Fcc: $70.00
? aPR 2 5 2002 ?
Phone # _
-------------------------------------------°--------------°----------°1,
I hereby acknowledge that I have read this application, state that the
with all applicable State of Minnesota Statutes and City of Eagan Orc
SfgnaTure of Applicant
agree to comply
OFFICF. USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Water Softcncr _
WaLer Heater _
_ No. of Baths
_ Phone #
Lawn Sprinkler
No. of R.I. Baths
Updated 4/02
1652
C. R. WINDEN & ASSOCIATES, INC.
. 1381 DEUSTS SURVEYORS
P1et AU64 M NN48b5108
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U. S. HOME CORPORATION
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Lot 14, Block 1, Johnny Cake `
Ridge Addition, Dakota County,
Minnesota
/
WE NEREBY CERTIfY THAT TMIS IS A TRUE AND CORRECT REPRESENTA?ION Of A SURVEY OF THE
BOUNDARIES OF iME lANO A60VE DESCRI6ED AND OF THE LOCATION OP ALl lUIl01NG5, If ANY,
TMEREON, AND All VISIBLE ENCROACNMENTS, IF ANY, FROM OR ON SAID tAND
Dorad this_l87)y day oF MAL A.D. 1980
C. R. WINOEN d ASSOCIATES, INC.
bY
Survapr, Minnewla Rapi?lrolion Ne.]'tZG
AV
CITY OF EAGAN
EARLY UTILITY CONNECTION PERMIT
1652 Covington Lane L14 B1 Johnnv CakP R;dgP
Address Subdivision/Parcel
I hereby request permission from the City of Eagan to connect to the
sanitary sewer and water lateral line in the public right-of-way. I
understand that the City has not yet completed, inspected and/or accepted
the sewer and/or water lateral. I agree not to use, test, or connect these
individual services to any interior plumbing and understand the require-
ment to cap the sewer service to prevent any unauthorized use.
In accepting this permit, it is agreed that I will hold the City and its
agents harmless from any damage that may occur due to this early connection.
It is understood that no Occupancy Permit will be issued or water allowed
to be turned on until the City utility system has been declared operational
by the City Engineer.
Signed by - Plumber: (110070Y Adon4,nklirnP K
Owner :
Developer•
Builder:
Dated: 5193/kn
I
CITY OF EAGE.,4 SEVIIER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagon, MN 55122 DATE:
Zoning: No. of Units: ,
pwner:
Address: -
Site Address:
Plumber: 1 agree to comply witfi the City of Eagan
Ordinences.
By
Dote of I nsg.:
Insp.:
CtTY OF EAG. __ .
's7kS Pilot Kno6 Road
Eagon, MN 55122
Zoning:
Owner:
Address:
Site Address:
Plumber:
Meter No.:
Size:
Reader No.:
I agree to eomplp with the City of Eagon
Ordincneea.
By
Date of Irtsp.:
Connection Charge
Account Deposit: .
Permit Fee:
Surcharge:
Misc. Charges: ;
Totol:
Date Poid:
WATER SERVICE PERMIT
PERMIT NO.:
pATE:
. No. of Units:
Connection Charge: +
Account Deposit: ?
i
Permit Fee: ?
Surtharge:
r.
Misc. Charges:
Total:
Dote Paid; '
I nsp..
CITY OF EAGAN
3795 Pilof Knob Raod Eagan, MN 55122 N? 7441
- ? PHONG 431-8I00 2 -
BUILDING PERMIT $300 Receipr #
To 6e urd hr MASONRY FZREPI,ACEto. Volue S5?ggg Dote Auqtist 12 _ 19 82
Sik Address 1652 00Vin4tOri Iane E,"t g) pccupancy
Lot 14 Block i Set/Sub.170hnnY Ck. Rd4. lSt Aher ? Zoning
Porcel # 10 39800 140 0l Repair ? Fire Zone
Enlarge ? Type of Const.
rc Name _. _QArl?.'3 6kFl1}476 RMi7 tsx Move ? # Stories
Z Address 1652 Covinatan Tane
o DemoGsh ? Length_
ci Ea4an 55222 phOte 452-2624 Grode ? Depth Sq. Ft.-
p Name ? ?tZ ApProrals Fees
~ 2325 Uplander Dr. N.W.
?? Addrest
i- r:... Aridover 553011 7r 5_aIA t
Nome _
Address
I hereby acknowledge Ihat I have reod this applicotion ond state thaf
fhe information is correct nnd ogree fo comply wifh oll opplicoble
$tate of Minnemta $tatutes q(iNCAy of Eogan Ordinonces.
Sipnoture of PermiMea -?
A Building Permit Is issued to:
oll work shall be done in acco
Building Offlciol
Permit 11.7U
Surcharge •$0
Plan check
SAC
Water Conn.
Water Meter
Rood Unit
TMOI 512.00
on tha express cond7tlon thno
Stalutes ond City of Eogon Ordirwnces.
??? f/?! CITY OF FAGAN Include 2 sets of plans,
?? ? 1 site plan w/e].evations &
BLJILDIIQG PERMIT APPLICATION 1 set of energy calculations.
7b Be Used ForRasontw? Valuation C)CD Date
sit.e Aaare55 I6s1. Covly,oTon LanQ oFTzcE vsE orrLs
Lot f ? slocx f s?./sub.?E`?recr
Parcel #: 16 3 1 ?o C? /?o o? Alter x oninan?
9
Rvner; ?A??5 S???S l?pair Fire Zone
Ehlarge Type of Const.
Acklress: 1652 Qz-vv ??oY1 ?R. M°"e # Stories
?d Demlish Front ft.
City/Zip Code: ?Y\ S rj Grade Depth ft.
Phone #: li5I- 7-62L\
Contractor: Yd (..v-T2-
Pclclress: Z??S kp`i,c_w dE t- pY- ' PJV
City/zip Code: 14" ?'' - ;irbpVP?r, ON SS?y3
Phane #: _7GG 1
Arch./Ehg.:
Address:
City/2ip Code:
Phone #:
Assessmenf -
Wuter & Sew.
Palice _
Fire
Eng.
Pionner -
Council _
Bldg. Off. _
APC
APPROVAIS FEES
Assessnents Perntit ? 3p-
T4ater/Seaer Surcharge ?
Police Plan Check
Fire SAC
Eng. Water Conn. _
Planner Water Meter
Council Road unit
Bldg. Off.
P.FC
16,60 ;0?-3 s9 7,
ZVPAL 75
CITY OF EAGAN Np $16 9
3795 Plloe Knob Rood Eagan, MN 55142 •
_ YHONF: 454-8100
BUILDING PERMIT Receipt # l's
Te M uted far DECK Est. Volue $1,000 Date ,7une 20 1 q 83
Sita Address 1652 Cov ington Lane
7?
E
R-3
j
rect Occupancy
14 1
Lot Blotk Johnn Cake Rid
Sec/Sub. y ge 1sAIter ? Zoning R-1
Porcel # 10 39800 140 Ol Repotr ? Fire Zone NA
?
Eniarge
?
TyPe ot Consr.
a Name Charles & Melinda Shults
W tilove
p
.#
5rories
z Address 1652 IIovin ton Lane
g Demolish ? Length 16
o C; Ea ean 55122 phOfe 452-2624 Grade ? Depth 28 Sq. Ft.-
p Nome OWIleT Approrals _ Feas
r
0? Addrea
f n...
Name _
Address
1 hereby o[knowledge thot I have read fhis applicatian ond state tFwf
the informotion is correcT and ogree to wmply with all opplicable
Srote of Minnesota StotutQSpqd.City of Eagan Ordinances.
Signolure of Permittee
C arl
A 8uilding Dermit is issued to:
CII work sholl 6e done in accordan[e wifh nll
Buildfnq Officiol
Assessment Permit 1! .7V
Water & Sew. Surcharge • 50
Police Plun check
Fire SAC
En9• Water Conn.
Planner Water Meter
Council _ Road Unit
Bldg. Off.
APC Total $1$ • 00
on t he express condition Ihnt
sofa_Statutes ond Ciry of Eopan Ordinances.
CITY OF EAGAN Include 2 sets of plans,
1 site plan w/elevations &
BUILDING PERMIT APPLICATION 1 set of energy calculations.
Zb Be Used For Valuafion 0c)? Date
site naaress f ?c4V INCrto ri L?NE- orFzcE usE oNLY
Lot I q slorac ? sec./sub.3•C,?-, gxect -2?_ a-cupancy
Parcel # : fS 0 C] Alter Zoning ?
?ur Fire zone
aaner: .. ?U arJe Type of const.
Address: I6'5). COV1NCt'Y* Lfl}'VT? j"bve # Stories
city/zip code: EI?G?i?1 ? ??lish _ Front ft.
m Yl? ?j f`1.?. Grade Depth ft.
Prone #: 452-262?
APPROVALS FEES
Contractor: NpNE /SCL-F Assessnents Permit
Address:
City/Zip Cocle:
Phorie #:
Arch./Ehg.:
Address:
City/Zip Code:
Phone #:
T9ater/Sewer Surcharge
Police Plan Check
Fire SAC
E11g. Water Conn.
Planner Water Meter
Council Road Unit
Bldg. Off.
APC
cirr oF E?G+N
3795 Pilof Koe6 Raad Figan, MN 55142 N2 5678
PHONE: AS ".100 ,?% ; ,! ?
BUILDING PERMIT APPLICATION
re be uma for S/F Dwla/Gar Esr. vaim 60.00
Site Address 7652 C_nvi_nQfnn T.n.
Lo214- BlockI? Sec/Sub. Johnny Cake
porcei # Ridge
Zg
u°
r
w I Nome Clrris? Thnmpsan FiGmGs---
3 Address 1712 Hopkins Crossroad
O .
Name _
Address
Name
PMne
I hereby ocknowledge thot I have read this application and state thot
the information is correct and agree to comply with all applicabie
StaM of Minmsato Stotutes and City ot Eagan Ordinunces.
Receipt *
Erect )n Occupancy B3
Alter ? Zoning R1
Repair ? Fire Zone 'A
Enlarge ? Type of Const. -51
Move ? # Srories
Demolish ? Froni 5.4 ft.
Grode ? Depth 41; ft.
Approvala Fees
1
ASSessment 3 / L V 10
Woter & Sew.
Police
Fire
Eng.
Planner
Council
Bldg. Off.4 /4 /R!1
APC
Permit 1 Sd _ 6f1
$urcFwrge 30 00
Plan check 77 95
$AC S9S nn
Water conn. 3 nr;_ n p
Water Meter 6 0 0.0
narl iTnif 1A5 0 0
Totol 1316 ti 75
Signoture of Permittee I
A Building Permit is issued to: o1ipsOR HOIDES on the express cnndition thct
oll work sholl ba done in accor ? wit a licable State Minnesota Statutes and City of Eagan Ordirances.
,Pf
Building Officlal ' -
,?? CI^Y OF F1?,AN Include 2 sets of plar
? 6v ' 1 site plan w/elevat1.
BUILDING PERMiT APPLICATION 1 set of enei.?gy calculat ms.
Rb Be ed For ReswEMce Valuation ? Date MRfi 1c, 10. 9 0
Site Address: JIoS,?, IDWIU6SoN Lw CMoocL yl) OFFICE USE OHI,Y
Lot 1`l slocic sec./sub. =adNNv cnKe Erect v occupancy
R%oc.r? Alter Zoning ?? -
Parcel #:
Repair Fire Zone
Owner:
Address:
City/Zip Code:
Phone #:
Contractor:
Addr255: a Division of U. S. Home Corporation
ov r. S GROSSReiEB
}71n urf
City/Zip Code: MINNETONKA, MINN.55343
Phone #: 544•9333
Arch./Fhg.:
Pddress:
City/Zip Cade:
Phone #:
Enlange _ TYpe of Const. ?
Nbve # Stories
Dennolish Front ,sy ft.
Grade Depth y6 ft.
APPROUALS
`1 ?
71%2?
'
Assessments Pexmit 1S
$
Water/Se,aer Surcharge 3 0 ?-
Police Plan Check-??
Fire SAC
EM, WatPS CAnn. 3 O S=
planner Water Meter a ?
Council Road unit / Irs 9;?
Bldg. Off.
APC
T= /.336.7s'
This request void
18 months from '
Date oF this Request ?? I? Fire No. v 6 Xi• ei •,J ?.J
I, as I? Iacensed Electrical Contractor O Owner,jq hereby tequest, y' ?spection of the above electri-
cai wYiuig installed at: ?/`7? / / ?.1E - 9CG?? .
Street Address or Route No. Ctim W? Lr1 City??s/` 31?
SecUon Township Range County [-)? IW3h
Which is occupied by
Is a roughin inspection tequired on this job? No ? Ye091, Ready Now O Will Callga;
Power Supplier ? Address
Electrical Contractor'+ ?gyG}?? ? Contractor's License N?
Mailing Address _
I ll? ? (L?Lil ?TeA?
?onpactor or Owner Making This Installatlon) ?/
Authorized Signature 7 4' Phone No, aqO `SSOS
(Eix[rital Cantn<tor or 6wfAn?apr DMaking This Inatallatlon)
STAVE BOAoy u u ?,?`D ?Q?J?r Thisinspectianrequertwillnotheacceptedbythe
State Bwrd unless proper inspection fee is enclosed.
Minnesota State tloarC of Electricity
Griggs Midway Bldg. - Room N791 1914Q`.a-, EB-00001•02
1827 University Ave.. St. Paul, Minn. 55104 -Pryone 297,2111
RfQJEST POR ELECT-RICAL INSPECTION (?
CHECK BELOW WOCcIC COVERED BY THIS REQUEST J 6 4 3 8
Type of SuAding New Add. Rep. amk pPpliancey Wired For Check Equipment Wired For
Home
Duplex ?
? ?
? Range
W uev? Temporary W'ving ?
ApL Bldg.
Commercial Bld
?
?
?
?
?
? , eater
Dr
F ?
? Lighting Futures
Electnc Heating ?
?
g.
4 Silo Unloadet ?
Industrial BIdK. 0 0 ? A'
d
?
Facm
O
h
?
?
?
? on
Li
rs?
?er
L•?-? Bulk Milk Tank
Lis[
thers? ?
[
ex ? ? e ?
e
1
re
wmruM 1NSYbCTION FEB BELOW
Service Entcance Size: # Fee Fceders&Subfeeders: # Fee Cucuits: # Fce
0 to 100 Amps. 0[0 30 Am eres 0 to 30 Am eres /Ta 0
101 to 200 Amps. 31 to 100 Amperes 31 [0 100 Am eres zv
q
Above 20(_Amps. Above 100 Amps. Above 100 Amps. ,
Transformers Remo[e Contxol Circ. Partial or other fee
Signs S cial Inspection Minimum fee $
Remazks
TOTALF
r r
(Final)
This request void
18 months from
has been m`adF'
Date ?c7&4'C)
??a[e .r ? . -?r(.1