1065 Diffley Rd - Electrical Permits2 V V-13 314 OFflCE USE ONLY Thls request vaid 18 manths fmm validmian dore pnnied in ihls box
/55
7 l?9/99
PLEASE PRINT OR TYPE
R est Dak Rougbtn Inspection required2 es ? N. Inspectian Other Than Roughlm 0 Ready? ill Coll
(You must mll the inapMOr whan rea y) Data Rea y:
I,icensed conhodor ? owner hereby request inspedion o# Ihe abov eledr' r ?
Job Pddress (SHeet, Bor, or Rauk Na,j
/o(ps DIFFLE 2a Ciry Z'
6-.4 ? ?z
Saction No. Township Name ar No. Rang<No. Fire No. Caunry
P'4t<or
Occvponl
/40L1 Sr T?o S ?
Power Soppller addr.,.
'DA TrE
Eletlnml Conbacbr (Compony Name)
{4,t.tD-1?io EuL.cT' Commnor License No.
C,qa t37 Mosrer Lic. Na (Piom Elea. Only)
Moilirg Addrees (Contraclar or O+me. Perfarmog Inswllmion)
/ 2? ?4D ? K? M? PJ S/ 2
AuWo}faSignoNre?Co erP iigln?alalian) PhoneNo.
EB-OO001A10 6/95 STATEBOARffCOPY-SEEINSTRUCTIONSONBACKOPYELLOWCOPY
IIII II I?I I II REDUEST FOR ELECTRICAL INSPECTION 10,4APT
Minnesota State Board of Eiechicify 1827 University Ave., Rm. S- 28, St. Paul, MN 55104
* 0 28 6 1 3 3 4 * phone-t6,t2Z842-0900 Home Duplek Apf. Bldg. Other: New Addn
Commercial Indushial Farm Remod Re air
Air Cond. Hfg. Equip. Wafer Hfr. load Mgmf. Other.
D er Ran e Elec. Hea} Tem .$ervice
"X" v6ove the work covered by this requesi. Enter remarks in this space and on }he back o/ the white copy anly.
GAs g r>-`t-(o P/`C,.ErL. w)4s tF
Calculate Inspection Fee - This Inspection Request will noi be accepted without ihe <orcect fee:
Olher Fee # Serrice Enimnce Size Fee # Circuih/Feeden Fee
Mo6ile Home Park Stall
l 0 to 200 Amps p 0 to 100 Amps ap
Street Lig./iroffic Sig. I Above 200 Am s 846.6 Above 100 Amps .?
Transfortner/Generator INSPECTO ' ONLY TOTAL
$ign/Outline Ltg. Xfmr. ? ZQ i S?
Alarm/Remote Conhol ?? ?
Swimming Pool ---_`
m : ected Ihe nml' : o d on the dare, :
Z
Ifli9ation Boom
$p ecial Inspection Dok
R
Investigative fee Dok
4
Final p
THIS INS7ALLATION MAY BE ORDERED D CONNEC ED IF COMPLETED WITHI4 1 8 M HS.