2969 Inland Rd - Electrical Permits?`°
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fleQU'red ady Now Q Wfll Nobfy, Inspeo-
g -30-'85 iaYes ?No tur When p¢atlv
?Licensed Elecltical Con[rac[or I ryereyy repuest inaDectian ot abava
Owner eleehical wrark imta11e0 at:
5lreet Atld,ass, Box or RoWe No.
a%1? Cfiy
.cuon o TownsAiO Name or No. Nange No. Coun[y
?- 771
Occupanl IPRINT) Phovie No.
om Pl , SZ - 39 7
Power $uDVlier Atldress
Electrical ConVactor (COmpaM Name) Conhanur's License
I?L_r r ' i 109,16,Fr-*2
Maihnq Address (C tractor ar Owner Making Instaila[ion)
g W. FiS? L k2 ( 04o2a ?ue. f???SS369
Autho ized SiB"ture (Conttactor wner Makinp Installation) Phone Number
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YINNESOTA STATE BOARD OF ElECT111CITV THIS INSPECTION pEQUEST WIIL NOT
Gripps-MidwaV Bldg. - Room N-191 BE ACCEFfED BY 7HE STA7E BpqRD
UNLF55 PROPEN INSPECTION FEE IS
7821 University Ave., SL Poul, YN 56100
Phona 16121297-2111 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECROW-. Es-oooo,-w
, See iatruetians for conio1¢tim this fam m beck oT yollow coOV?j
e48559 "X" Be1ow Work Covesed by This Request ?. ?
Atltl Reo. Type oi BuiMmg Appliancas Yiirad Equioment Wired
Home Range Temporary Service
Duplex Water Heater Lightiq Fixmres
ApL BuilAmg Dryer EIecVIC HeaUn
Convwercial Bldg. Furnace Silo Unloader
strial Bldg. Air Conditioner Bulk Milk iank
M Other cen ther (SVerify)
i,r Syeu y ther O?M1er
omnute lnsnection Fr.r. Below
k Fee Se,viceEntrsmceSiie q Fqe Faedars?Subfaeders Circwts
0 to 200 Am 0'to 30 Am ? tn 30 Ane
Above 200 Amps 31 to 100 Amps E 31 to 100 Ampt;
Swimming Pool Atnve 100-Am s f - A6ove 100_A
Transiortner5 Irtigation Boo'rs Partial'Other Fee
Signs $pecial IiispecIion ?)
Bemerks 9? TOTAL PE?,•QJ/
?
qouph-in j
/ :?(t; +y3 Date
'i?"Lb the Eleevical
Inspector. heraby
ca1?lhBl lh0 abpvB
Final
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yV? ?Y pae<ion has Eeen
-de.
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