4410 Jan Echo Tr - Electrical PermitsREQUEST FOR ELECTRICAL INSPECTION
b, See mslrucM1Ons for completinq [his Porm an back oi yellow copy ?
? ?
"X" 8elow Wo?ed 6y rhis Request ??i;5 1/
Ne Add Rep. Type of Building ? Appuances Wired Eqwpment Wv
?
Home j Range Temporary Service /
Duplex I Water Heater Electric Heahng
Apt Building ? Dryer Load Management
Comm./lndustrial ? Fumace Other (Specify)
- Farm Air Conditioner
O[her(specJy) Con[reotora Remarks
Campute Inspection Fee 8elow. (J- I ? Pccl-k ` Lk) rv!!,,?o rv ?
I
# Other Feel # Service Entrance Size Fee # Circwts/Feeders Fee
Swimming Pool ? 11 0 to 200 Amps ? D to 100 Amps
Transforrners Ahove 200_Amps Above 0-Amps '7.1)6
Slgns I Inspector's Usa Onry TOTAL
lrrigation Booms I >? a ??,50
Special Inspection ?
Alarm/Communication THIS INSTALLATION MAY BE O OfSCOtJNECTED IF NOT
Other Fee ? COMPIETED WITHIN 78 MON7W3.
I, the Electncal Inspector, heretiy
tit
ih
t th
i
ti
b
a Rou9n-m
. / oa?e ?
cer
y
a
ove
nspec
on h
e a
been made. I s .
Final
oate 3 Y/
OFFICE USE ONLY
This request void 1 8 moNhs tro.
0? - 40
? . ?-'
,
Requ [ DatB
? ^ V
? frte N
I Rou InspecbOh Reqwretl
(YO call inspector when reatlyl
? inspecbon OtherThan Rough-In
? Reatly Now ?I Nohiy Inspecror
I
1 No
s Oate Read
I? licensed contractor ?owl er hereb
uest ins
edion of above electrical work at
re
y
q
:
p
dob Atldress (Sheet, Box or RoNe No ) Qty
I
? r
Seciron No Township Name No Range No County
Occupan[(PRI n ? ^ m I
i1^y 1 (? (
? V Pnone No
PawerSUppLer
? G Address
L-I o0 220'I'tA ?- ,
EI ?ncal GonUador (GOmpan Name)
?OII
A--
a Con[rec[ors ?cense No.
D i
.
.
c p
Mailing Atldress (Conhactor or wner Making Installa[ion)
_TK
PakO M N 5) o?
a?t s
Authonzed Signa[ure (COMractor/Owner Making In tallaM11
? Phone ? Numbe/??
MINNESOTA STATE BOAFU OF ELECTRICI
GNggs-Mitlway Bltlg. - Room 5128 THIS INSPECTION REOl1E5T WILL NOT
BE ACCEPTED B, THE STATE BOARD
1821 UNVerslty Ave., M. Paul, MN 55104
P6nnn IBV\ Gd>.OMII UNLESS PROPEP INSPECTION FEE IS
1un nem
?3
95
REQUEST FOR ELECTRICAL INSPECTION 14-?r?
10- See inslructions ior completing ihis form an back of yellow capy.
"X" Be/ow Work GIIIIIIIIIII by This Request
Ne Add Rep. Type of 8uilding Applia Wired Equipment Wued
Home Range Temporary Service
Duplez Water Heater Electric Heatin
Apt. Building Dryer Load Management
Comm./Industrial Furnace Other (Specify)
Farm Av Conditioner
Olhar (specAy) CoNreotor's Remarka:
Tc> v? r11o t?.
I oo-A "
Compute Inspecfion Fee Below:
# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Swimming Pool t 0 to 200 Amps 157,00 I 0 to 100 A s $,Op
Transformers Above 200 Amps I Above 100' mps 7,U0
SI nS Inspecror's Use Only TOT L
Irrigation Booms ?-' ? ?
T
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE O - NNECTED IF NOT
Other Fee COMPLETED WI7HIN 18 MONT /1)
I, the Elecirical Inspector, hereby_
if Rougn-m oq? y
cert
y Ihat the above inspection has
6een made.
oate / YJ
OFFlCE USE ONLV ?
This reQUesl voitl 18 montps irom
0 9 95 339
Reque DaN
b- ? Fre o Rcug u?red
(YO ca .ctor when resay) Inspechon Other Than ugh-In
? qeady Now Will Nahly Inspecfor
Ves ? No pate qeatly
I liCensed contractor ? owner hereby request inspection ot above electrical work at:
Job Ad ress (Sireet, eox or Rou[e No ) Qy
ac&X ? ^'
Wf 1
Sechon N. Township Name r No Fange No Counry 1
• <V ' ?
Ol J ccypan[(?1NT) ? ^ i' ?? Nx-p Ph?NoS--t_ ZQ?
PoyW?erS?Uppl1rer'- Mtlress /7o
ElecMqal Cont recfor (CO ny Name) Contrecbfs License No
s? CNooyt) 10
? ?c?-
.
a?Hrg App? 5(COn ot o? Owner Mabng s1alWeon) ?
U '{ ,?? I ?_ 1V I? 107
S ? J
AWhor¢ed Signature (ConVactotlOwner Makinq Installa?mt??J Phone
Number
/? (y
V
• l /?• ?'V?1
MINNESOTA $TATE BOAflD OF ELECTRIGITY
Griggs-Mitlway Bltlg. - Room 5-126
II
II
I
I
I I
I I
II
II
I
I THIS INSPECTION REQUEST WILL NOT
8E ACCEPTEO 9Y THE STATE BOARD
1821 Unlvereity Ave., 51. Paul, MN 55704
Phone(612) 642-08D0 UNLESS PROPER INSPECTION FEE IS
ENCLOSED
??J% REQUEST FOR ELECTRICAL INSPECTION ??? ??pp? ?
? ? See mslmclions fur ?ompleUng this torm on beck of yellow copy ?P
/9 q5 "X" Below Work Cov,ered by This Request •??.
Ntki? Add Rep. Type of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heatei Electnc Heating
Apc Bwldmg Oryer Load Management
Comm./Industnal Fumace Other (Specify)
- Farm Av Condi4oner
OtM1ar (speaty) Conlrar.mrs Pemarks ?
Compute Inspectron Fee BelowI??
# Other Fee f{ Service Entrance Size Fee # Circuits/Feeders Fee
$wimming Pool 0 ta 200 Amps ? 6? 0 to 100 Amps ?
Transformers Above 200 Amps Above 100 _Amps •J, oa
Si ns inspeaor s use oniy TOTAL
Irngation Booms
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE ERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Elechical Inspector, hereby
b
i
rf Rough-in Dat y?C?J
y that the a
ove
ced
nspection has
6een made.
F??a?
OFFICE USE ONLY
This reques[ voitl 18 months fmm
?
338 80
1'=
?9? ?l? ?'
6
77
Fleques5 ate ? Frte N. ougM1- speciwn Reqwred In echon OlherThan Roughln
(YO call mspecior when reatly) ? Reatly N. WAI NotHy Inspector
Yes ? N. Date Featly
I- licensed contractor ? owner hereby request inspection of above electrical work at:
Job Atldress (SVeet, B. or Rw[e No )
6 Gty
-H 15 e,r
Sedion N. Township Name o No Range No Counry
O n?(PP T) Phonq,
PowerSUppher Atltlress
-?--
Electtlcai Conirador (GOm ny Name (r, Conha/cro`r's/,Lice?nse ?No
ilingAddress (CoMr d r or Owirer Mabn stallauon) ? ????W-d 5607
N
Authonzetl SignaNre (COnVaqor/Owner Meking Installation) Pnonne?Numbe?Wr
nW ^(?
35
MINNESOTA STATE BDAHD OF ELECTHICRY
Gfiggs-Mitlway Bltlg. - Room, 5-126
II
II
I
) THIS INSPECTION REQUEST WILL NOT
BE ACCEPTED BY THE STATE BOARO
1811 Unrveniry Ave., SL Paul, MN 55104
Phane (812) 642-0800 . . UNLESS PROPER INSPECTION FEE IS
ENCLOSED
REQUEST FOR ELECTRICAL INSPECTION 110, See insimchons lor comple0ng this form on back of yellow ropy ?
"X" Below VF'ork ?ceered by This Request
New Atld Rep Type of Building Appliancas Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt Bwiding Dryer Load Management
Comm /Industnal Furnace Other (Speafy)
Farm Air Condrtioner
Other (specdy) Goniraatore Femarks -
Compute lnspechon Fee Below: Iw_ N? TO 1 ?' `V`i
# Other Fee
4
# Service Entrance Sze Fee # Circmts/Feeders Fee
Swimming Pool 1 ( 0 to 200 Amps I 0 to 100 Amps .aO
Transformers A6ove 200 Amps 700 Amps
SIgt1S InspeHar's llse Only T TAL
Irrigahon Booms ?, -rJ-O
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE OR D DISCONNECTED IF N07
Other Fee COMPLETED WITHIN 18 MONTH
I, the Electrical Inspector, hereby
trf
th
t
h Rouqn,n e/ pai
cer
y
a
t
e above inspection has
been made. -
F'"a?
Da[e
OFFICE USE ONLY
TMS reques[ voitl 18 months lrom
/
0 -P 5 ?,3 7 ?? ?O ?
F2quest ate
??Q (? ?
?
l?? R. No oug?- spectwn Reqwretl InspecUOn 01herThan Rough-In
(Vou s? call inspecto[yfen reatly) ? Reatly Now ?WAI Nobfy Inspecbr
J
f Yas LJ No Date Ready
I- Klicensed contractor ?ownar hereby request inspection of a6ove electrical work at:
Jab, AtlItl're1ss (S^Jl're?eq 9ax or RoNe No )
? Gryr
`'1`1
? L? V? t?
Sec[mn No Township Nam or No Range No Counry
'baK0
Occupant(PRINT) ?N
LlI T ? Phone No2`5?
l'
Prnver upplier ` ` Atltlre?sjs?,?
V"'?..k.l ` W V I-[.l?' 1 \ \ V ?C?/ ? \? 1
? • V ?/L ? 1
Elecmcal Contrector (COmpany Name)
(
4 ConVaciols License No
O
, .
.
V O
Mailing Adtlress (GOnirector or Owner Making Insrellavon) 5?`
\O I M
N 55107
Authonzetl Signature (COntractudOwner Making I taUalwnj Phrnre Number
a LI-a933
G
N
v
'C Y
B
A I
I I II I I II I III II I 111 111 11111 111 B?E OT
' E
vero ty A
1
82 9U
Pau SMN 55104
e.,
St
GM1nna Ifl1T fd9.(?Gll(1 I
? UN ESS PRDP
R INSPECTION
13
o1111 C
?f , REQUEST FOR ELECTRICAL INSPECTION ?
??•? J ? See msmietions for oomplehnp Ihis Porm on back o( yellow copy
`?i%9/?s "X" BelaHC bVocv_ered by This Request
Ne Add Rep. Type of Building Appliances Wiretl Equipment Wired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Bwlding Dryer Load Management
Comm./lndustnal Furnace Other (Specify)
Farm Air Conditioner
other(speciry) Comrqctors Reinarks
I To W?koM-?
Compute Inspectron Fee Below: Op-.4?-&p
N Other Fee # Service Entrance S¢e Fe its/Feeders Fee
Swimming Pool 0 to 200 Amps O Amps ICK
Transformers Above 200 Amps [ 0 _Amps
Above ?
Signs b
inspec wts Vse Onry TOTAL
Irrigation Booms -7-7, 5O
S eaal Ins ection
Alarm/Communication THIS INSTALLATION MAV BE ORDERED DISCONNECTED IF NOT
O[her Fee COMPLETED WITHIN 18 MQP{TR6.
I, the Electncal Inspector, hereby
tif
th
l th
b
i
i
h Rough-m
? oar
cer
y
a
e a
ove
nspect
on
as
been made. -
Pmal ? Da[e
OFFlCE USE ONLY
This request vatl 18 monlhs hom
? 9 i?5 43 6 ? 0,,a!_ &-,77 eo
ReQUe Date
(] r
_
-7- Fire No Roug nspecM1On Fteqwretl
(You us call mspeclor when reatly)
? Inspection OtherThan ough-In
? qeatly Now Wtll Natdy Inspetlor
I
J es
No Date Raetl
I ?91icensed contractor ?owner hereby request inspection ot above electncal work at:
Job Atltlross (SVeeL Box orqoute No)
yy l I City
G v?
Sedion N. Township N e or No Pange No County
Occupant(PRINn Phone No.
PowerSUppber Adtlress
y 22D`N? S?. Wils+
Elecfncal ConVactor ( mpany Name) CoMraIXOfs Lcense No
los ? .
• Aop l
MaNng AtlCress (Contrector or Owner Makin Installation?
/
SA- ` PD-W MN 55) 0^
T ?
Authonzetl Signature (ContracrodOwner Makmg Installatlon) Phone Number
-Q,m
MINNESOTA $TATE BOARD OF ELECTRICITV
Griggs-Mltlway Bltlg. - Room 5-128 1
11111
1111
I?
I
I
11
11111
1111
1
11111 THIS MSPECTION REOUEST WII.L NOT
1111 BE ACCEPTED BV THE STATE 80ARD
1821 Unrvaraity Ave., SL Vaul, MN 55104
Phone (612) 6/2-0800 UNLESS PROPEF INSPECTION FEE IS
FNG OfiFf)
.
? ?S.3REQUEST FOR ELECTRICAL WSPECTION ??h;I?y,?y
^/ ? Sea ins[ruolion4 br mmplating this form on back ot yellow copy
? y
y
(J //] ?P
??i 1T "X" Belovi: Work.(:overed by This Request NeH Atld Rep. Type of Building App6ances Wved Eqwpment Wired
Home Aange Temporary Service
Duplex Water Heater Electric Heahng
Apt Building Dryer Load Management
Comm.Andustrial Fumace Other (Speafy)
Farm Av Conditioner
O?har(specify) Conlraclors Remerks
Compute Inspection Fee Below:
# Other Fee # Service Entrance S¢e Fee # Cvcwts/Feeders Fee
Swimming Pool 0 to 200 Amps , Do 1 0 to 100 Am , o0
Transformers Above 200 Amps I Above 100ps Z,op
Si nS Inspecwr's Ose only ET
OTAL
IrngatwnBooms ;
5 ?
Special Inspection
Alarm/Communicahon THIS INS7ALLATION MAY BE ORDERED DISCONNECTED IF NO7
Other Fee COMPLETED WITHIN 18 MONT . ?
I, the Electrical Inspector, hereby
th
t
t RougM1-m oai '?/ c?
cer
ity
a
the above inspection has
6een made. oaie ,
7 '
OFFICE USE ONLV
This request voitl 18 mon[hs fmm
0-? g
l"-?
' 4 "
35 0
?
/?/
9
a
9
Reques D te
.. Fre No. ouqh-I pecM1On Reqmred
inspector
whN reatly) Inspection OlherThan qough-In
LJ!
? Ready Now Uy,Will Nottly Inspeclor
' ? p
I licensed contractor ? owner hereby request inspection ot above electncal work at:
Job Atltlress (Stree6 Box or Route No.)
[? Ciry
I
)?
Seclion N. Township Name o No Pange No County
O
Occu ant(PRI )
u?40 ? mo2 Phone No
C?Z-45 wo
PowerSuppLer ?
??,.Kn?a I ec?ri C Atltlress +
-12Qi? 5? . W.eSy
Eleclncal ConVaclor (COmpany Name)
4 V ? . Wy1 ?. W? Co/Mracrofs L¢ense No.
? ?/ OLo
Mailing ptldreas (ConVa or or Owner Making Installali,on)0 ' ?07
? C C..1
3.J
U Ll?
Autrnzed Signawre onlractor/Owner Meking Installab Phon? ?? S3 3
i1
MINNESOTA STATE BOAHD OF EIECTPICR
Griggs-Mitlway Bitlg. - Haom 5-126 II I I I I I I I I I II II I I I I II THIS INSPECTION REOUEST WILL NOT
BE ACCEPTEO BV THE STATE BOARD
1821 Unlversily Ave.. SL Paul, MN 5510C
Phone (612) 642-0800 UNLESS PFOPER INSPECTION FEE IS
ENCLOSED
L¢ REQUEST FOR ELECTRICAL INSPECTION
? p ?g,c?o9ai ?a
Sae instmcM1ons for wmpleting this (orm on back ot ysllow copy t
+?+ g? "X" Below K5rk C6J'ered by This Request
?fil-9
Illf
New Add Rep Type of 8uilding Appliances Wired Equipment
Home Range Temporary Service
Duplex Water Heater Electnc Heatmg
Apt Bwiding Dryer Load Management
Comm /Industnal Fumace Other (Specify)
Farm Air Conditioner
Other (specdy) Conhacmr's Remarks `
? /?????Yj?(j? loo"
Campute Inspectian Fee Below: ??Y??'b
# Other Fee # Service Entrance S¢e Fee # Circwts/Feeders Fee
Swimming Pool ? 0 to 200 Amps 1$,00 11 0 to 100 Amps , o0
Transformers Above200_Amps 1 Ab 100-Ams ,oo
Si90S Inspecror's Use ONy TOTAL
Irngation Booms ?
z ee "1 CJ ()
Speaal Inspection e
AlarmlCommunication THIS INSTALLATION MAY B ISCONNECTED IF NOT
Other Fee COMPIETED WITHIN 18 MOMT ?
I, the Electrical Inspeclor, hereby
rti
th
th
i
h
b
h Roughin o
ce
y
at
ove
nspec
on
e a
as
been made.
Finai
OFFICE USE ONLV `-" ?
This request vaid 1 8 manihs (ro.
Request afe Fire No Ro?gn-I ? ion Requiretl
(YOU m callTispedor when reatly) inspeclion Ottier Than Rough-
? Ready Now ?A'ill NoIn?ify Inspector
A
Yes ? No Date Reatly
I licensed coniractor ? owner hereby request inspection of above electrical work af:
Job Atltlrass (Street, Box or Foute
No C4ly
ho r( l
`kLA o vl
$ection No. Township Name or N. Range No. Couny
?
Ocr,ypaM (P; IN? ^ Phone W.
2 O
Power Supplier
' Atleress
y S?. S
EI qncal Conlractor (GOmpany Name) 1 Co/nV?actoi s License No
1 ? L 1. 1 v• \ 0
Mading Atltlress (COrnV,a?c,.b.?r Owne, Makinyg ,In?sUlla)) ?KJ
?
w J
rQCT
?
<
1
Authonzetl SignaNre (COniradodOwner Making Installafion)
B
u
t- Phona Number
k--
a 10 O
j-t k 2 -
G
Umv
8
Y
e
' II (I I I I I I I I I I I I I I ATE
FO
III
i
EC
E
5t P uI
MN
5100
ersity Ave,
82 9
Plwna 46121 602-0800 1
? EN ELSSE
PER INSP
T ON
E
$
REQUEST FOR ELECTRICAL INSPECTION 4L
-See msRUCYOns for completing Ihis form on back oi yellow copy
"X" Below Work ! bvered by This Request _
Ne Add Rep. Type of Bwlding A.,anCgs Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Load Management
4
1 Comm /Industrial Furnace Other (Specrfy)
Farm Air Conditioner
Other (specdy) ConVector's Remarks ^{°
-
1W XA..A.p
Compute lnspechon Fee Below.
# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Swimming Poai 0 to 200 Amps 1S-,ocs 1f 0 to 100 Amps gS,°
Transformers Above 200 Amps I Above 100 _Amps 7.ou
Slgns Inspecmrs use Only TOTAL
IvigationBooms
O r
7
J6
Special Inspection ??
? •
AlarmlCommunication THIS WSTALLATION MAY BE ORD NECTED IF NOT
Other Fee COMPLETED WITHIN 18 MOl ?
I, the Electrical Inspactor, hereby
d
f
th R°°9n-tii / oar
ce
i
y
at ihe above inspection has
beenmade.
Finai ?d
°(l?C?e'`??
OFFICE IISE ONLY
This reques( vatl 1 8 monlhs hom
&342 N
1*
??
L
aam,
4
?
1
.
,
Reques Date
(A Fre N. ough-? ec100ReOmretl
(Yo?m call mspeclor when ready)
? Inspec0on Othe, Tha ough
n Ready Now ill Noinhfy Inspeclor
?`
{ ? N.
es Oate Featl
Iglicensed contractor ?owner hereby request inspection of above electrical work at:
Jbb Atldress (Sireet, Box or Roote N)
?f?
l
l
?
h
a'r
- bly
-
S a.?n -
L
,
v
r
Section No Township Name or No Pange No County
77 ko t-
????Pant?PRINTJ ? O& km czx
'T Phone No
f? ?_5?O
Power Supplier Adaress
Da.y-D-b- EIe.C??c- q3o0-ZZO-{'i,
Elecincal Contrac[or (COmpaO Name)
' vllin C,a 5+-. Conhactor's License No
c,Aoo(4 oCo
Madmg Address (COntrac[or or Owner Making Insbllahon)
S?r +- }. cu.a I
?1 N i o?
Authonzed SignaWre ( ntractod0 nerMakm Ins abwn)
Gb Q,rcv?. ? m Phone Numper
ZzLI -2S3
MINNESOTA STATE 80ARD OF ELECTflI TV
Grigga-MlUwey BIOg. - floom 5128 THIS INSPECTION REQUEST WILI NOT
BE ACCEPTEO BV THE STATE eOARD
1821 Universiry Ave., SL Paul, MN 55104
Ph- IR11\ Rd'l.fiMll UNLESS PROPER INSPECTION FEE IS
??irr ne?n
3t/ REQUEST FOR ELECTRICAL INSPECTION g,qppoi
??"?p' ,
Wio,s
110, See msimohons for compledng this form on back of yellow copy
"X" Be/ow Work Covered by Thrs Request ?5
?
Ne Add Rep. Type of Bmlding Apptances.yVired Eqmpment Wire
Home Range Temporary Service
Duplex Water Heater Electnc Heanng
Apt. Building Dryer Load Management
CommJlndustrial Furnace Other (Specdy)
Farm Air Conditioner
Other (spemly) Confractor's Remarks
lC6-A*-P TO t.Onr\\n-O
Compufe lnspection Fee Below:
# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Swimming Pool ? 0 to 200 Amps 15.00 l 0 to 100 Amps CjS, m
Transformers Above 200 Amps 1 Above 100 -Amps Z,pa
Slgns Inspemar's Use Only TOTAI
Irrigation Booms
Special Inspection
Alarm/Communication THIS INSTALLATION MAV BE ORDEREU DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONT
I, the Electrical Inspector, hereby
tif
h
h Rou9n,n oar
y t
cer
al the above mspeGion
as
been made.
F'"ai
D? a[e ? rc??
OFFICE IISE ONLY
This request witl 18 monihs irom
0- 9 y 43
Reques Date
Cl-f I
6 Fre No, ough- sp?qiron Reqmred
(VOU call ina?mw when reatly) Inspec[mn Other TM1an flaugh-In
0 Ready Now g Will Notify Inspector
' Ves ? No Da[aReetly
I 9 licensed contracior ? owner hereby request inspection of above electrical work at:
Job Adtlress (SVSeL Box Qc Poute Na_)
i G
?
4q 1 ho CA Ctih
Sechon No Township Name or N. Range N. County
1 v\
Occupar?i (P? Iry1
f T) ?
1 v w? Ptlone No
?J
Paver Supplier
?-a ElR-c,-hr;G Address
04+ WeS?
Elec[ncal ConVacbor (Company Name)
? C k'. C,o Confredofs Licrose No
cP?tooii
MaAm Adtlress (COnV ro or Owner Makinq I tallatron? ? 5? M N 55 107
Authonzed Signature (ConlraclorlOwner Making I stall n)
n% Phone Numpe? ^?
? Cb
MINNESOTA STATE BOAHD OF ELECTRICI Y
Griggs-Mitlxay 81Eg. - Roam 5428
INI
N?
I I
?I
INI
I
II
N
II I THIS INSPEGTION REQUEST WILL NOT
BE ACCEPTED 8V THE STATE BOARD
1821 Univeniry Ave., St. Paul, MN 55104
Vhone(612) 6e20600 UNLE55 PROPER INSPECTION PEE IS
ENCLOSED
?J .3 ? REDUE5T FOR ELECTRICAL INSPECTION °"?Po oi-
? s
Sce insVUdions lor completing Ihis form on back of yellow copy ??
4? "X" Below Work Covered by This Request ?„
Ne Add Rep. Type of Bwlding Appliances Wired Equipment Wire
Home Range Temporary Service
Duplex Water Heater Electnc Heating
Apt. Butldmg Dryer Load Management
Comm./Industnal Furnace Other (Specify)
Farm Air Conditioner
Ollier (specity) Cmtraator's Remarks
Compute Inspection Fee Below:
# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Swimming Pool ? 0 to 200 Amps 1,O0 1 0 to 700 Amps %.W
Transforcners Above200_Amps 1 AtQvp 100 Ams -1,oo
Si ns Inspector's Use Only TOTAL
Irrigation Booms 7so
Special Inspection
Alarrn/Communication THI5 INSTALLATION MAY BE OR ED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 1 MONTyS.
I, the Electncal Inspec[or, hereby
ni
th
t th
i
h
b Rough-in / l.??,v' oat? /
ce
y
a
e a
ove inspec.
on
as
en mad e.
Finei
/6 y?
oa?
FlCE USE ONLY
s request void 18 8 months Imm
rT
s344 'r3
? ' ? "v ?7??d"?
09
?
9
,RegAnI Dat
1 Fire No oe?h s04.^??on Reqwred Inspection OtherThn Rough-In
(YOU u call inspector when ready) ? Ready Now Wtll Nobty Inspector
Ves ? No Date Reatl
I)?licensed contractor ?owner hereby request inspection of a6ove elecirical work at:
Job Address (SVee[ Box or Route No ) Ctly
ko a ?
Secfon No Township Name or No Range N. Cou ty
Oc cu aM (PRi T) L
?1 Phone N.
"?
?' ? ` C)
Power Supplrer p Ad'dress
` 1
Electncs{ Conlmctw (Comparcy NamS)
I License No
Con?ra 7
(
nS . oo O
O
Maibn Atltlress (COnVacror or pwner Makinq Inslalla?ion?
`l ? Str -r S.7110uu l MN 55107
Authonzetl Signature ontractorlOwner Making Install Uon) Phone Number
6O I ? ? -ZS 33
MINNESOTA STATE BOAFD OF ELECTNICIT
Gtlggs-Mitlway 91dg. - Hoom 5-028
I
I THIS INSPECTION REQUEST WILL NOT
BE ACCEPTEO BY THE STATE BDARO
1821 UMvereity Ave, St Paul, MN $5109
Phone (612) 642-0800 I , ONLESS PROPER INSPEGTION FEE IS
ENCLOSEO
REDUEST FOR ELECTRICAL INSPECTION A'i`.y'g;.,
? ? ? S. inedmcirons for compieong irns iortn on back ol yellow copy
! ?
"X" Below Worh.Covered by This Request
T
Ne
Add
Rep.
Type of Building :-.
Apphances Wired
Equipment Wired
Home Range Temporary Service
Duplez Water Heater Electnc Hea[in
Apt. Building Dryer Load Management
Comm./Industrial Furnace Other (Specify)
Farm Air Conditioner
OUet (specdy) CnnVactor's RemaMs
Compute fnspection Fee BalawI00^ A-hAp ?UV V n? O?
# Other Fee t! Service Entrance Sze Fee # Circuits/Feeders Fee
Swimming Pool ? 0 ta 200 Amps S.aO 0 to 700 Amps loo
Transformers Above 200 Amps Above 700-Amps pa
SIgnS Inspecmr's use Only TOTAL
Irrigation Booms -7 I,
Special Ins ection
Alarm/Communication THIS INSTALLATION MAY B DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS,
I, the Electrical Inspector, hereby
certify that ihe above inspection has
been made. R°ughin /?i
?
Fi°ai C? oa?e
ae`?/ ?
OFFlCE USE ONLY
This requesl void 18 months fmm
s345 [A
? " t 4
v
/
Req st Dat
/?'`' ?? (,?? Fre No. flough-In t?on uiretl Inspedion Other Tlan Rough-In
(VOU mu ca I inspeclor when rea0y? ? qeatly Now ?Will Noliy Inspecfor
Ves ? No Date Reatly
I licensed con[ractor ? owner hereby request inspection ot above electrical work at:
Job Atltlress ($VSet, Box or Route NoJ Qty
1 r
q I? V `0 1
Secnon No. Township Name or No Range No. Counry
Occupant(PRINT)
? ?AN C Phone rvo.
1 -
'bEQ p
PawerSUppber
F-
e l Atldress
S+-
4
-
ri
.
-ZzC
3
Elecmral Contxctor (Company Name) n Contractots License No
C
Y
C ADO O
Mailing Ad ess (Conhaciw or Owner Malting Instellatwn)
? fi?e? s?? Pcu.?.l A(U 55l 0-7
Authonzetl Sgnamre (COnlraclodOwner Mekmg Inslallahon) Phone Number
506 fA)'eA0tUt/--&A ZZ cf -ZF33
MINNESOTA STATE BOARD OF ELECTRICI
GrIggs-Midwey Bltlg. - Room 5128 I THIS INSPECTION REQUEST WILL NOT
8E ACCEPTED 8V THE STATE BOARD
1821 University Ave., St Paul, MN 55109
Phone(6121642-0800 UNLESS PROPER INSPECTION FEE IS
FNCLOSED
REQUEST FOR ELECTRICAL INSPECTION
G jli? See in.slruotions for complellng Ihis lortn on back of yellow copy
"X" Below W,ork Covered by This Request
Ne Add Rep. Type of Building Appliances Wired Equipment Wired
Home Range emporary Service
Duplex Water Heater Heanng
EIectric
Apt. Building Dryer 4 oad Management
Comm./Industrial Furnace ther (Specify)
Farm Arc Condrtioner
Other (spealy) Goniradors Remarks
IOOA-t•n.p _'6t,Jn_k%ot•A-0-
Compute Inspechon Fee Below:
# Other Fee tt Service Entrance Srze Fee !t Circwts/Feeders Fee
Swimming Pool ? 0 to 200 Amps p I( D ta 100 Amps ,00
Transformers Above 200 Amps Above 700 _Amps oa
Si ns insPamors use ouiy TOTAL
Irrigahon Booms 77,5D
Special Inspection
Alarm/Communication THIS INSTALLATIDN MAY BE 0 DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 THS.
I, the Electncal Inspector, here6y
if
th
t ih
b Ruuqn,n j l, 2??'
' oaP
cert
y
a
e a
ove inspeclion has
een made F'"ai oate
r
FICE USE ONLY
s reyuest voitl 18 months !mm
4 6 0
1,4
Requ st Date
(? /] Fre No ough-In c?lion Requiretl
(Vou II inspec[or when reatly)
? Inspecbon Other Than ougM1-In
? Reatly Now Will NoOty InSpecior
? ?
Yes
No Date Read
IXicensed contraclor ?owner hereby iequest inspection of above electncal work at
Job Atldress (Streel, Box or Route No ) ,
Hq lO c6-.o-'?rok-lk \ Qty
E av?
SecM1On N. Township Name or No Range No Counry
TO?
Occupanl(PRINT)
M?S o? M? r. Phone N.
52- 52c? o
Pawer SupPlier
? Aatlress
300- ZZoN-, ?-?-. W.eS--
Eledncal Contractor (Gompany Name)
V?\? CI • Y 1??, W? ConVacror's License No f?
DOqVW
MaiLng Atldress (Conhactor or Owner Makmg Installal?on)
p
j til S z 'ol
_
a'U
Authonzetl Signature (Contrador/Owner Making Installafion) Pnone Number
ZZYZ$
o
MINNESOTA STATE BOAHD OF ELECTIiIC Y
Gtlggs-Midway Bltlg. - Hoom 5128
1
1111
111
11 THIS INSPECTION REOUEST WILL NOT
eE ACCEPiED BV THE STATE BOARD
1821 UnlversRy Ave, 5t Paul, MN 55104
ox.w [gim aeznvnn UNlESS PFOPER INSPECTION FEE IS