3901 Danbury Tr - Electrical Permits
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R uest Date Fire No.
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Re ui?ed9 ? ReadY Nm" ?will Notlfy Inspector
9 When Ready
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I? licensed contractor ? owner hereby request inspection of a6ove electrical work at:
Job Address (Street, Box or({? ?ute No.) / CitY (/?"? ?y,
1- (.riC 6/n
SecLOn No. TownsMp Name or No Rarge N. Counry
OccupenY(PRINT) /?f Phone No
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Pawef pplier
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71 Atltlress
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Elecincal ConVactor (Gompany Name) .
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Connaclor§ ense
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CX(??KS
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Mailmg A dress (Contraclor o owrrer Making Inslallazion)
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AuYhorrz Signawre (Cpnirutwlo?ner /TMak, ing ellatmn)
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MINNESOTA STATE BOARD OF ELECTBICITY THIS INSPECTION (iEQUEST WILL NOT
GriggaMidway BItl9. - poom S4TJ BE ACCEPTED BY1HE STATE BOARD
1821 Oniverelry Ave., 5[. Paul, MN 55106 UNLESS PROPER INSPECTION FEE IS
Phone (612) &12-0800 ENCLOSE?.
REQUEST FOR ELECTRICAL INSPECTION ? ee-oaom-m
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? See instmcLons for complebrg iMS torm on back oi yellow wpy
^X" aalnw wnrk Covered bv This Request
123 ti v
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" TypeofBUilding .
AppliancesWired
EqmpmenlWired
Home Range T emporary Service
Duplez Water Heater Electric Heating
Apt Bwlding Dryer Other (Specity)
Commllndustnal Furnace
Farm ' Air Conditioner
Othee (specdy) Contrflc1or5 Remarks
fe Inspection Fee Below.
Olher Fee ServiceEntranceSize Fee # Circurts/Feeders Fee
mming Pool 0 to 200 Amps Z/t/ 0 to 100 Amps
nstormers Above 200 _ Amps 00 Amps
p
ns hnspector5 usa Only ? TOTAL
ation Booms
cial Inspection
rm/Communica4on
er Fee `.?U
Date
Electrical Inspector, hereby Rou9h-in
4
that the above inspection has p,,,ai
made.
USE ONLY
from
est voitl 18 monihs from
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