3912 Danbury Tr - Electrical Permits18is request voitl m 7 -
onths (rom ?? \J?. O d 9'v 2
E 6 2 9 5 )-.?e
Reqo¢st Uate Fire No. Nou m In
1 ? SV6CbOn
_ 1? Re0 etl? t?JW.AV Now DWill NoLtV InsPec-
? ?Yes ?No 10, When flea0y
Licensed EIecViwl Contractor
? Owner I hereby re0uest inspection oi ebova
Streel Address, Baz or Poute No.
emion o. Townsh,0 Name or No.
i C_
F?nge No. ry V Cliy
E?
Co
Occupant (PRINT)
Phon¢ No,. I ^
P
ow¢r Supplie? Adtlress
Elec cal Conhactor (Comuany Namel
???t? ELEC1l2 Cnntrar,tor's License No.
MaiJmg Atldress (COnt actor pr Owner Makin Ins1Ai1 ionl QQQ /
A ?? ???
uthonzedSi ?utur
8 Conhactor er Maki
n Installnl,on) "
Phon¢ Nom
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i?
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I
Griggs-Midwey Bidg?-mqoom N 187 FKI?
??T
1821 Universitv Ave.. $L Paul. MN 56104
Phone (612) 642-0800
^'? '->rcC i PON NEQUEST WILL NOT
8E ACCEPTED 6Y THE STqTE BOARD
UNLESS PXOPEP INSPECTION FEE IS
ENClOSED.
REQUEST FOR ELECTRICAL INSPECTI y
/cr
ON es-oooai-os
2 ? Sea mstructions br complahng Ihis torm on Geck ol yellow copy. O ??
LS 6295 "X'' BBlow Work Covered bv 7his Renuesf
Ad? Peo- "vae of Builem¢ aaoliancwa Wiraa e?? W?reA
' Home - Fang¢ Service
Duplex Wa[er Heater ixtures
Apt Bwidin? Dryer eatui
Commercial Bldg.
Furnace i
Jcr
m
InAustnal &d Av Conditfoner ank
Farm
.,iv?
t nr ucnfY
nR l/1//? P
N a Above caEntrence5¢e
2DOqm 5
200 q?????y h Fee Fexders/5ubfeedels
Oto30qm s
31 to 100 qmps N FeR Grcmts
Om30Am s
31 to 100 q
s
ming Pool q?vE 100Ampy
siormers rrigation Booms
s Special InspecLOn
Nema.ks
S IO
? Above 100Amps
Partial. r Fee
T AV6EEh
Bouah-in ? -
Dale
?. ?h lecv
f ' insoecto., ne.eev
Final , p(? certily thet the above
?'?? inspection hes been
metle.
RIIB fB0Y85t vOId 18 montln fram
This reQUest void ??
16 rronths (rom d
D 3 3 6 8 Y ?;? /?, .2_,?%:
7/1'2 0
_
fteqrest Date ..._ _
Fire No.
?. .
?. - -
qouph-(' InsVecbon
Re?
d1i -
L.?.
ire ?Neady Nuw ?Wdl Nnbfy InsDec-
?es ON tor Whe R dy
mf
`? _._?..??? ?•??•••"• `?••`??`?O? I herabY ?e9uest inspection ol above
? Owner elecfrical -4 m.mu.n ntStreet Address, Boz or Roure No. ?ity
39/2 ? .,; I F
ect?
n
o
o. Townshi0 Name or o. qange No. Count
R .,"Y
Occuu.M (PqINT) Phon¢ No,
b
Power Suppber
AAdress
?
f-ie ? C ? 1w'iq4 hQl
Eleoln :al Conhaclor ICompany
Nemel on ractor's L?r.ense No.
/
f/1 J)v.[- FICP T riv
O cv
-
Ma ing AdJress Contmctor r Owner M
a
kinu ??stallatmnl
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Authon etl Sien ture IConha od ner Makmg Installat1On1 Phone Nvmber
9,2 ; 71
mrvwuiq STATE BOAflD OF ELECTRICITY
Gripps•Midway Blde. - Room N-191
1821 Univarsilv Ave.. St Peul, MN 55104
Phpne (672) 642-0800
iMIS INSPECTION ItEQVEST WILL NOT
8E ACCEPTEO BY THE $TATE BOAFlD
VNLESS PNOPEH INSPECTION FEE IS
ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION . ee-aoooi- ?
/ See insnructwns br comoleting thia form on bnck o( Yellow copy.
D 32Cj.87 .'X" 8e/ow Work Covered by 7his Reouest
aXi 'Reo. rype or Bioia?ne Applmnroa WiroE eautuniene wiren
Home Range orary Serv?ce
Duplex
Apt Bwlding Water Heeter
Dryei iny Fixtwes
n?: Neatin
Cnmmercial Bldy Fumace Unloader
E
Industnal BIAg. Air Condiuoner BUlk
Milk Tank
F2rm O?he, peo v 15 poc?lvl
m .,,. ? 1 .... ............ r_" n_i_ ther
M Fae ServicaEniranceSize X Fea Feeda1s/5ubieeders 4 Fn¢ ts
? ? Am s 0[0 3 0 qm s 0 to 3s
%
Above 200 qm??y 31 to 700 qinps ,c-" 31 to m s
Swimming Pool Above 100_Amps 100
Above _Amps
Transtormers Irngation Booms Partial. Other Fee
$i gns Speaa I I nspe ct i on
Hemarks $.elfC' TO7AL F
Aough-in L v
Dme
,?e Elect.??
nsDectoq he?eby
Fnal ceriify thet ihe above
A?r inspeclion has been
mede.
TObrepueslrolElBmonlhatrom ? ' ???