3160 Neil Armstrong Blvd - Electrical PermitsREQUEST FOR ELECTRICAL INSPECTION
, See instructions lor completing ihis form on back oi yellow copy.
N5 2761 "X" Be/ow Work Covered 6y This Request
?-
? e6V I
???
ew Atld Rep. TypeofBUilding ? AppliencesWired EquipmeniWiretl
Home Range Temporary Service
Duplex Waler Heater Electric HCating
Apt. Building Dryer Load Management
Comm./Indusfrial Fumace Other (Specity)
Farm Air Conditioner
Other (syecdy) Conhaclor's Remerks:
Compute Inspection Fee Belaw: "llit
# Other Fee # ServiceEniran Size Fee # Circuits/Feeders Fee
Swimming Pool 0 ta 200 Amps ljgjo 0 to 700 Amps
Transformers $ A6ove 200 _ Amps A6ove 100._ Amps
Signs . Inspecror§ use only: TOTAL
Irrigation Booms
Special Inspec[ion
Alarm/Communication THIS INSTAIlATION MA)P3F ORD -6f6CONNECTED IF NOT
Other Fee . Q COMPLETED WITHIN NT
I, the Electrical Inspector, hereby
tif
h
h
i Rouqn-In ? oatr?,a f_"Y
Q
cer
t
at t
e above
ns ection has
Y P
been made. Finei ? oa? ?? j 7 Q
OFFICE USE ONLV j
mis request voie te momns Irom
v ?
? s
iieQuest Date
J(?
? 7 Fire o. Rough-in Inspection
ReqY Sd4 ?o
eetly Now O Will Nolify Inspector
When Reatly7
Ilicensed contractor ? owner hereby request inspection of above electrical work at:
Job Atltlress (Street. Box or Route No.)
3icPo ne??
?t? Ciy
EA G-.??v'
Section No. Townshi0 Name or No. Ren9e No. County_ ?
OctupanllPRINTf
?IVI ST?I? sw?.
C/o .?k" P?one No.
6t 2- ysZ-7ss 8
Power SuOPlier
I?cko-rb £,?.Ga?i..2 Atltlrass /'YV.??
y3oo _ 22o4k, l.xsA .??-b?,
s roL(o
Elecincal ConhaMOr ICompany ame)
S,( ? COntractm§ Licensg No.
03-7s 82-r
Mailing ACtlress ICOn[raclor or Owner MaMmg Installation)
Aul) i ea Si awre iConlradonOwner Making Inslalletionl
,e
rT,..
? Phone Number
MINNESOTA STATE B PD OF ELECTRICITY
Gdg9e-MlOway Bltlp. - Room 5173
1821
Unl
lt
A
SI
P
l
MN
d
?
a THIS INSPECTION FEQUEST WILL NOT
gE ACCEPTED BY THE STATE BOARO
SS PROPER
NS
ECT
O
PEE
S
.
verc
y
ve.,
.
.
au
5510
3 8}
Phone (612) 844-0800 ?n?nM . (O
iMy? S.?7 2/ UNLE
I
P
I
N
I
ENCIOSED.
REOUEST FOR ELECTRICAL INSPECTION EB-00001-08
lp II ? See instmclions for completing this lorm on hack of yellow copy
"R" Below Work Covered by This Request
?s
13917 `
e Add Rep. TypeolBuilding AppliancesWired EquipmentWiretl
Home Range Temporery Service
Duplex Water Heater Electric Heating
Apt. Builtling Dryer Other-(Specity)
Comm./Indusirial Fumace G.al
Farm Air Conditioner 1 KF :r
Other (speay) ConVacmrg Remarks: L`ta
5- o-s? uan 7
Compute Inspection Fee Be/ow: 70=
N Other Fee # ServiceEntrancaSize Fee x Circuits/Peeders Fee
Swimming Pool 0 to 200 Amps Q to 700 Amps
Trensformers ,s(!U2 r Above 200 A ps -J :-? Atrove ro Amps ?°,
SignS ''f' /°f" Inspe<mr5 Use Only: T
q
7'AL ?
trrigation Booms ? 7? , ?
/
R 72?
SpeCiel Inspection
AlarmlCommunication THIS INSTALLATION MAY BE ORD DISCONNECTED IF NOT
thar Fa<?,j COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby
if Rouph-in ' Date
cert
y that the a6ove inspection has
been made. oete
OFFlCE USE ONLY
This re0uesl voitl 18 monihs irom
This request void
18 rtronths tram A 084894 L 13 6 1 TA, co ?500
Hequest Date Fira No. Po h-in InsVaction
Rea ired?
?Aeatly Now Will Notity.lnsPec-
g?
?' ?Ib S cr ? ?es ?No r M?hen Ready
XLicensetl Elecvical Gontractor I hereby request insoeetion o1'e0ove
? Owner eiaclrical work installed at:
Sveei AACress. Box or Foute No.
s
?
C?
`F" N
/
? Ciry
Lvo
oR?
e?
.unsr?wN
a
.
ecLOn o. Township Name m No. anee No. Gounly
' 0Ako7?9
Occup?antA(P81NT)-
[?•^'/'W LV?'J'P Phone No.
Power $uppliar
N s. O- Atltlres3
Eleclri I Contractor (COmpany Namel
C
1 Conhactor's License No.
4 --?66
o ,
- cc? 22
,
Mailine AdJress (COnt?rector or Owner Maki?n-g Inst/ai?la[ion) /?,
/-/
E
"
'
Z
.
7
t LLrY/c/L.C J; /??UL r/! ,
7
L
AuNorize
d Si natur (Co ntr tor/Owner Makin Installat'on) Phone Number
/
G ?
MINNESOTA STATE BOANU OF E NICITV THIS INSPECTION NEQUEST WILL NOT
GriBBa•Midway Bldg. - Room N•791 BE ACCEPTED BY THE STA7E BOARD
UNLESS PHOPER INSPECTION FEE IS
1821 University Ave., St. Peul. MN 55104
Phonn 16121297-2111 ENCLOSED.
l?f,l( _- REQUEST FOR ELECTRICAL INSPECTION EB-°°°°''°"
? y? , See instruetions for comDlatin0 ihis fwm on back ot vellow eopy.
/q 08'4 8 94 "X" Below Work Cove/ed by Thrs Request
Inl«AAaa1 pewl ivoe oi OwlCina 1 Aooliencea wcred 1 Equipmont Wired 1
N Fee ServiceEnlrance5ize k Fee Feetlars/Subleedera N Fae Circuits
? to 200
qm s 0 to 30 Am s /8 0 io 30 Am
A6ove 20
0 qm ?s ? 37 to 100 Amps 31 to 100 Am s
Swimming Pool Above 100_Am s Above 100_Am s
Transformers Irrigation Booms ,y'o Partiai." ee
L ? I Signs ' I ISpeCial Inspection 'S Q
Hemarks S TO L/FF?+?/\
U /W ?
Final
thet the aEOVe
'.ion hes been
//'S
TMS request voitl 10 months trom -
This request void IS months &om 0 ?
. `?sq R 85526
Date of this Request Z4#2" ? -77
I, asN Licensed Electrical Contractor 0Owner, do hereby request inspection of the above electri-
cal wiring,installed at:
Street Address or Route No. F'drity /?/?
Section Township Range County /,1K?
Which is occupied by
!s a roughin inspection required on this job? No tg
Power Supplier
Electrical Contractor ? ? K' ?
/ (CJOm?' yINam
Mailing Address r.?? .Yi!/k
(Electr `al Contract
Authorized Si¢nature .51':?
of occuoanry
Yes ? Ready Now 1&. Will Call ?
ress l?A.PM/tiviv
? ontract ' Lse o.?
P .
ner Mak/in9 Tnis Installatlon)
v? Phone No. 927- 9ZC17 Z
jcsocn¢ay?:oniraccor or vwner maKing i nn ms[aiuiionj
?
SVAYE BOARD CO?jj'?? This inspection requestwill not he eccepted by tha
?`?' SWte Baard unless pmper inspection fee is enclased.
Minnesota State Board of Electricity <Qn???
_ 7954 University Ave., St. Paul, Minn. 55104-Phone 645-7703
REQUEST FOR ELECTRICAL INSPECTION R 85526
CHECK BELOW WOItK COVERED BY TH1S REQUEST
Type of Building New Add. Rep. Check Appliances Wved Fot Check Equipment Wired For
Home ? ? ? Range ? Temporary Wiring 0
Duplex ? ? ? ? Water Heater ? Lighting Fix tures ?
Ap[. Bldg.
R ? ? Dryer ? Electric Heating ?
Commercial Bldg. ? ? Fumace . ? Silo Unloadei ?
Industrial Bldg. ? ? ? Air Conditionex ? Bulk Milk Tank ?
Farm ? ? ? List ) List
Othe[ ? ? ? p
}
Hehelsl p
Heiers?
COMPUTE INSPECTION FEE BELOW
Senice Entmre Size: it Fce eeders&Subfeedus: - x Fee Cucuits: # Fee
0 to 100 Am s.
' 0 Am s 0 to 30 Am eies ? .1?, rJ?
101 to 260 Amps. f ;
? 31 A es 31 to 100 Am eres
Above 200 Amps.
Transformers
Signs Ab 0 p
Re teC :o
S ecial lns ction Above lO?Amps.
Partialorotherfee
Minimum fee 55.00
Remazks '
TOTAL FE
I, the Electrical Inspector, hereby certify that the above inspection has been a??n .2.°?
(Rough-in) Date ?
(Final) C/. ?? /G,
This request void 18 months from -dommobift-
This request void 18 months from 59
R 85527
Date of.this Request
I, as,!kl,icensed Electrical Contractor ? wner, do hereby request inspection of the above electri-
cal wiring installed at:
Street Address or Route No. -D / b U 9A?mH W t City
Section Township Range County 9/2/d .?0
Which is occupied by /r/al?l!??,?iES/ ?/'???
(Nama 7 Occupant)
Is a roughin inspection required on this job? No ? Yes JEL Ready Now ? Will CallID
Power Supplier Address _ T/??/Y///'„c7/?Ci?
Electrical Contractor `5ultxz?°rt '00'?3
ntractor s License o._
7 ?Comva y rvame
Mailing Address ??p .? -?
lectric Contract or Owner Making Tnis Installatlon)p
AuthorizedSignature ?xe.n?.Z,.•? PhoneNo./?J'? 1
5?ppp (Elect?ricqal tractor or O???wpppner Makln9 Thls Installation)
??? EJ ? ????( "??? ?y This impection request will not be accepted by the
u ?? F? State Board unless praper inspeetion fee is enclosed.
" - Minnesota State Board of Electricity
9954 University Ave., St. Paul, Minn. 55104-Phone 645-7703
'.'-REQUEST FOR ELECTRICAL INSPECTION ?y R 85527
Cb1ECK,BELOW WORK COVERED BY TH1S REQUEST
Type oP Building New Add. Rep. Check Appliancea W'ved For Chect Fquipment W ired Fm
Home ? ? ? Range ? Temporary Wiring ?
Duple;t ? ? ? Watei Heater ? Lighting Fintures ?
Apt. Bldg. El ? ? Dryer ? Electric Heating ?
Comme[cial Bldg. N ? ? Fumace ? Silo Unloader ?
Industrial Bldg. ? ? ? A'v Conditionei ? Bulk Milk Tank ?
List
? List
Other ? ? ? .
Rehers?,_
f Oehers?
H 1
COMPUTE INSPECTION FEE BEt:OW:,. . 1
to
Remarks
• uJ,?.t?/ .u?
I, the Etectrical Inspector, hereby
(Final)
This request void 18 months from
TOTAL F
has been m-dde-
Date or-I " ?
Date ?-7-
This request void /s/8',
18 months from .
C 36541 /-1-
ouM?ru? ? oVCCUmi
eqmred7 Neatly Now QWill Notity.lnsoec-
5 - o / ?Yes ?NO [or When fleady
?
A Licensetl Electrical Conttactor 1 hereby request inspection ot ebova
?;Owner eleefrical work installetl at:
Sve¢t Address, Box or Route No.
/1 0 .KsKr?.. City
.V,?j
ect?on o. Townshio Nflme or No. nge No. Cou
?
Occupant (PqiNT) Phone No.
i / C s',& l?Es
Power Su lier
Cr Add ess
Electrical ntractm 1F ompany Name)
"
= Conttactor's License No.
?
/f
_C .B iv62-A S se5a:, 1
e_ D D O S -.?
MailinB />tldress lContraclor or Owner Makine Instailationl
r
v. ? 3 ?v? ,V .
Authorize 0n81u IConvact Owner Makina Insiallatiool Phme Numbar
??G 3 ?
MINNES TO pTE BDAPD OF 6LECTRIGITY . THIS INSPECTION XEQUEST WILL NOT
Griqgs-Mitlw y BIdB• - poom N-181 BE ACCEPTED BY THE STATE BOAHD
1821 University,Ava., St Paul, MN 55104 UNLESS PflOPEH INSPECTION FEE IS
Phnnw 16121 297-2111 ENCLOSED.
7 REQUEST FON ELEC7RICAL INSPECTION E73?'?
JO See instructions lor comOleting this rorm on back ol Vellow coPy.
t. 36541 "X" Below Work Covered by This Request 7
,.ab aeo. Tvoe ol Builtling ' Appliuncea wir.a Enuiument Wired
Home Range Temporary Service
Dupiex Water Heater Lightiny Fixtures
Apt. Builtling Dryer Electric Heatm
Commercial Bldg. Fumace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tenk
Farm tner par,i y rhE:r ISnorifvl
t .r Syecify Othpr Other
Compute lnspectron Fee Below
M qCFee ServiceEnlraneeSixa 11 Fee Faxders/Subfeeders # Fne Circuits
? 0 to 200 Am s 0 to 30 Am s 0 tn 30 Am>
Above 200 qm ps 6- 37 to 100 qmps to tU0 A
Swinunin Pool , Above 100_Am s 100_Amps
;Above
_ y Transformers Irngation l3orc?s tial-bther ee
SignS Specialinspection TOT
Nemarks L F E ,
A
/ ?i/_n ?
? w
1 flough-in ?ha Ela '
InsDector, herehy
n certify thet the above
Final eetion has been
Tlih requesl void 18 montlm Irom
9?79/9i
1 /10 .7 00 9
p 2 3 0 4 9?g-
,?,
4
Request Date Fire . Roughin Inspection equ
R
tl' U Reatly Now )o Will Notify Inspector
.Tllly 26 ,1991 }t Yes
i No When Ready?
IE-licensed wntracror ? owner hereby request inspection of above elecirical work at
Jo0 Atldress (SlreeL Box or qoute Na-) Giry
3160 Neii Hrmstron (East Half) Ea an
Sec?ion No. Towns?ip Name or No. Fange No. County
Dakota
Occupant(PRINT) Phona No.
Kristco
Power SuDPiier Atltlress
Eiectncai Contracior (Company Name) ConvaMOr's License No.
.Prairie Electric Com an 040597-7
Mailing HOtlrass (Cantrecbr Or Owner Mdhing In s[lllld0on)
6595 dale B Suite 1
n Pr
irie MN 55346
, e
a
Amhorr o i9 re iGonvaclor r M king Installation) Phone Number
949-0074
MINNESAS?E ?0! ID,9FELECT?HICTV \ gEIACINSPECTION
CEPTED BV THEOST TE BIOAFDT
G.Iqgs-idway BICg. - Poom 54)3
1821 University qve.. St. PauL MN 55100 l1NLE55 PROPER INSPECTION FEE IS
Phone(61Y)fi4P-0800 ENCLOSEO.
13894 REQUESAIIII10-rELECTRICAL INSPECTION
9Q/? ? ? See Instmctions far wmplat?ng Inis lorm oc bock oi yellow aopy.
? "X" Below Work Covered by This Request
ee-oaooi-oa
/oa19
ew Atld Rep" Type of Building AppliancesWired EquipmentWired
Home Pange Temporery Service
Duplez Water Hea[er Elec[ric Heating
Apt. Building Dryer Other (Specify)
X I Comm./Industrial Fumace
Farm Air Conditioner
Otner(syecify) Gontreclork Femerks:
Tenant finish
Compute Inspection Fee 8elaw:
# Other - Fee # Service EnlrenceSize Fee # Circuits/Feeders Fee
Swimming Pool : 0 ro 200 Amps $ 0 to 100 Amps 32.00
' Transformers A6ove 200 _ Amps Above 100 _ Amps
' Signs inspemors use oniy: NTAL
trrigation eooms 32.50
Special Inspection ?
Alarm/Communication THIS INSTALLATION MAY BE ORD DISCONNECTED IF NOT
Other Fee Sux'ChaY e.50 COMPLETEO WITHIN 18 MON S.
1. the Electrical Inspector. hereby Ro°9°-'" r oaie ^?
certify that the above inspection has
been made. F;nai ?
J
OFFICE USE ONLY
This re0uest voitl tB monchs Gom.
a 43927 1
•
Hequesf Date Fir o. Rough-in Inspection
R
? y
[I Ready Now (] Will NMily InspBCta
Februar 1, 1991 equiretl
m vas ? No wnen aaaayz
10 licensed contractor ? owner hereby request inspection of above electrical work at:
JoE AAOress (Slreel. Box or Roule No.) Gry
3160 Neil Armstrong Blvd. Ea an
Section No. Township Name ar No. Fange No. Counry
Dakota
Occupent(PRINT) Phone No.
Bruck Plastics
P4rcr Supplier Address
ElecMCal Contracmr ICOmparry Name) ComracWrS Licensa No.
Prairie Electric Company 040597-7
Mailimg AOeress (COnVacror or Owner Making Installa6on)
659 denvale Blvd., suite 120 Eden Prairie, MN 55346
Authori tl- nawre (CO rlOvner Making I Ila' n Phone Num?er
949-0074
MINNE?OTA STATE BOAflD OF ELECTFICITY TNIS INSPECTION REOIIEST WILL NOT
Origgs-Mldway Bldg. - Haam S173 6E ACCEPTED BV THE STATE BOARD
1841 Univenky Ave.. SL Paul, MN 55104 UNLESS PROPEF INSPEC710N FEE IS
Plq. (612) 86E-0800 ENGlO$E0.
i,?n _?_.? h REQUEST FOR ELECZRICAL INSPECTION
????'?/v ll? See ins uctions fw tom0leting ihis form on back of yellow mpy.
a4 3 9 2 7A/?I4/?X" Befow Work Covered by This Request
?d?jT, E&00001-OB
ew Atid Rep: - TypeofBmtling AppliancesWiietl EquipmeniWireO
e Range Temporary Service
ex Water Heater Electric Heating
Building
Apt. Dryer Other ( Specity)
# m./Industrial FUrnace
Air Contlitioner
(specity? ContractorS Remarke'.
Tenant Finish
Compute Inspection Fee Below:
F Olher Fee # Service Entrance5ize Fee S Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Translormers Above 200 _ Amps Above _ Amps
SignS Inspeciw5 Usa Ony: 7pTAL
trri9ation Booms
Special Inspection
Alarm/Communication THIS IN5TALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee urc ar e. CpMPLETED WITHIN 18 MONTHS.
I, tbe Electrical Inspector, hereby AOUgh-in
certify that the above inspectiOn has
been made. Final Date
?
OFFICE USE ONLY
This requesl voitl 18 monihs Irom
ThiS re
18 mm . ?
_ 36539
Hequest Date Fire No!/ Roupfi-in Inspectidn
U R quirea? fleatly Now []Will Notify Inspeo
S a" ? ' Yes ?No ror When Ready
?Lioensed Eleclrieal ConVacmr I hereby request inspaction of above
? Owner alectricai work instelled at
Street Atldress, Box or Noote Na. Gitv .
1 . a .?, ,„, ?
ecLOn o. Towns ip Name or o. , flan o. Co nt
Occu aM (PqIN ) PhOne No.
f
?
P wer Supplier . Address -
*
ompany Nemel
Electrical C?tr actor Cuntractor's License
N
o.
?
O. ? ?l!/"Y?T?i'$. {?9.A.? . ?
/?? [ ?
'
I
Q o 7 °J
Maflm A Jress (Contwctor or Owner Makine'InstailatioN
v 43 IAX- ,2-7
17 Z-al
sv
AuMorize natur ( ontlac Owner MakinB Insiallatlond Phone Number
'7? G 3 a
MINNESOTq pTE BOAMD OF E CTRICITY. ' THIS INSPECTION qEQUEST WILL NOT
Grigga-Midw eltlg. - floam N•191 BE ACCEPTED 6Y THE STATE BOAND
UNLE55 PXOPEH INSPECTION FEE IS
1821 University Ava., St. Peul, MN 55104
PAnnw 18121 2972111 ENCIOSED.
REQUEST FOR ELECTRICAL INSPECTION ?yeen-o?o/00i.oa
)P Sea imtruetions tor comoletiny this form on back o1 Veliow copv.
3 6 5 3 9 "X" Below Work Covered by This Request
AAtl NaD. TYPe oi Buil0in0 p.OCliancea Wired EquiVment Wired
Home Range Temporary Service
Duplex Water Heater Lightiny Fixtures
Apt. Building Dryer Electric HeaUn
Commercial 81dy. Fumace Silo Unloader
Industrial Bldg. Air Conditioner Buik Milk Tank
Farm Other peci v ehue ISnar.ilyl
t er Sueci y Othm Othur
Comuute lnsvectron Fee Below ..- n,"t
tl Fee SarviceEntteneaSfza tl Fe Fextlees/Subteeders # Fee Circuits
0 to 200 qm s 0 to 30 Am s 0 to 30 Am
Above 200 qmps 31 to 100 qmps 31 to 100 A s
Swinming Pool Above 100-Amps Above 100_Am s
Transiormers Irn tion Hooms Partial.'Other Fe .
Signs
ertarks Specialinspection $
.? '
TOTAL FEE
?! e
d•
-,
flauph-in Oate , ihe Elecviw
r ?soectoq hereby
Final certilV «1 the above
spection hes been
? tle.
1 i ?
tliMreQueetvoi018montMirom " --•?? ? C1V'? _4?
J ?
Faquest Date ? F No. Rough-in Inspect
RequireC?
? ves 9TJO
? Feedy Now ? Will No1ity Inspector
When Ready7
IG&ensed contractor ? owner hereby requeffi inspection of above elect(cal work at:
Job Addreas (Sireet, Box or Raule No.) City
? D,
Section No. Taxnship Name or No. Raige No. Counly
Occuparil (PRINT) PMne Na.
S ? DL
Power Supplier p??
/r
Eletlrical Contractor (Co pany Name] Coniraclor§ License No.
Meiling AEtlress (Comrector a Owner Melmg InsWlation)
L
AuMOnz Sgnature (COnvact?ner ing In tellati )
T. e Number
bi1NNE TA STATE BOApO OF ELECTRICITY THIS INSPECTION REOUEST WILL NOT
rlggrMitlway Bltlg. - Noom S1173 BE ACCEPTEO BVTHE STATE BOAPD
18Y1 niversiry Ava., SL Paul, MN 65109 UNLESS PROPEP INSPECTION FEE IS
Phone(612)86Y-0800 ENCLOSED.
' ?y
LJ' O13111
REQUEST FOR ELECTRICAL INSPECTION
? See insVUC[lons for completing ihis form on back Ot yelbw copy.
X" Below Work Covered by This Request
? EB-00001-07
/
e Adtl Rep. Type of Building AppliancesWired EquipmeniWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specify)
Comm./Industrial Furnace
Farm Air Conditioner
Olner (specity) ConvactorS RemaMS:
Compute lnspection Fee Below: F-M p ?
# Other Fee # ServiceEnvanceSize Fee # CirouilsJFeeders Fee
Swimming Pool 0 to 200 Amps o ta 100 Amps Q
Transiormers Above 200 _ Amps 100 _ Amps
Signs Inspeclor§ Use Only: ?j TOTAL
Irrigation Booms
2o?a?
o
Special Inspection
Alarm/Communication
Other Fee P.
I, the Electrical Inspector, hereby
certify that the above inspection has
been made. Rough-in ?•,?z? ;
Final ? ?e ^ Jr
? -M
OFFICE USE ONLY
This request voitl 18 manths irom
M?527?6 1 l
Requen Date
O- - F. N. Rqyghdn Inpse$lion uir d
(VOU must can inspe ttwhen
? Yes ? No Inspedion Other Than qough-In
tly) ? Reatly Now ? Will NotHy Inspector
Dale Reatly
I icensed contractor p owner hereby request inspection of abovB electrical work at:
Job Adtlress (SVeet Box or Route No.l City
Seclion No. Townshlp Name or No. Ranqe No. Coun(y
Occupanl(PRINTI
G Phone No.
Power Supplier Atldress
2
ElecVical Con[raclor (COmpany Name) ('qnimdor5 License No.
/
Malling qddress (COnUact r or Owner Making Instaliation)
nutnoriz iqnature IGoMrectonOwner king In lation) Pnone Number .
.14INNOTA STATE BOAHD OF EIECTRICITY THIS MSPECTION REQ4EST WIIL NOT
GHg MiCway Bldg. - Poom 5413 BE NGCEPTED BY iHE SWTE BOARO
1041 University qve., SL PauL MN 55106 UNtESS PROPER INSP$CTION FEE IS
Vhome (812) 862-0800 ENCLOSED.