1100 Diffley Rd - Electrical Permits•?„/?/y6
Request Date
J
'/yG
No.
4 -
` O ( cI'
h-In Inspec[ion Requiretl Inspection Other Than Rough-In
must call inspector when reatly) ? Reatly Now ? Wiil Nolity Inspea...
? ves ? N Oate Reatly
Ig licensetl contractor ? owner hereby re
Job Htltlress (StreeL Box or qoote No
OD ) j% 7 $F
Section NoTownsnip N
Occupant(PRINT)
Power Supplier Atltlress
DAW
6
-
Elearical Contracror (COmpany Name) Comractor's Licanse No.
' L'-6' 17I CT , ? " o I
Mailin Atltlress (COniracror or Owner Making Installation)
l ,<f ?L 0
Auth$ zetl SignaNre (CVactor!Oe ar Mnki Insta ion) Phone Numpe,
..._?.__L
ACCEPTED UNLESS PROPER INSPECTION POEE 13
?82 9U5?5?1 Y Ave, BSt oProm au SMN85 104 'C T
.
Phone (612) 642-0800 ENGLOSED
REQUEST FOR ELECTRICAL INSPECTION e- '-Ee-OOOOt-os
?? Sea ins(mclions for completing Ihis brm on back ot yallow copy. <f?' 4 ;
"X" Below Work Covered by This Request ????••
0 094 560 ?';,'"?'
Nel Add Rep. Type of Building Appliarice? Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Load Management
Comm./Industrial Fumace Other Specify)
Farm Air Conditioner
Other (specify) Conirdctor's Remerks'.
Compule Inspection Fee Below: ?t???C ??18e-z'
# Other Fee k Service Entrance Size Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 10D Am s a
Transformers Above 200_Amps Above 700 -Am s
Slglls Inspector's Use only: I TOTAL
Irrigation Booms % l?
Special Inspection ?
v?
C
Alarm/COmmunication THIS INSTAL
RDERED nISCONNECTED IF NOT
Other Fee S? j) COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby
tif
th
t th
b R°°9n;n oate
cer
y
a
e a
ove inspection has
been made. F??ai oa?
OFFICE IISE ONLV
Thls reques? void 18 monlM1S Imm , "'-
ELECTRICAL INSPECTlue.
0? See Insimclmns br complefing this fonn on beck of yellow aopy. •
Y
0 2 4 6 0 Below Work Covered by This Request
ew Add Rep. TypeofBuilding AppliancesWired EquipmeniWiretl
Home Range Temporary Service
Duplex Wa[er Heater Electric Heating
A L Building Dryer Other-(Specify)
CommJlndustrial Furnace
arm Air Conditioner
? Olner(sVecityl
Compute Inspection Fee Below.' Convacmr5 Remarke'.
# Other ? Fee N S mrance Siz # Circuits/Feeders fea
Swimming Pool 0 00 mps ! to 100 Amps
Transiormers Abw 200 - mps Above 100 _ Amps
Signs inspecmr's Use Omy. OTAL/)b
Irrigation 8ooms 6% ?
??
Special Inspection Q
Alarm/Communication TMIS INSTALLATION MAY BE ORDERED D ONNECT D IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Elearical Inspector, hereby Ro?yn-m /l1 Date.? V
L
ceriify that the above inspection has
been made. F;nai oete
?
OFFICE USE ONLY
This request void 18 months irom
??02 6 b?x??c,-oN ?,t
s? c
Requesl Date?- I- ?? Fire No. Rough-in Inspection
Pequiretl?
?Yas r
? Re94y Now ity Insp
'h'henReaGI Q?
I ?ensed contrac?r iow? hI64by request inspe n t above electrical work at:
Job AEdress ISVeeL Box ar PoNe NoJ
•'//C"? ' l- - _ , 4 Ciry
SecLOn No. Townshlp Name or N. Range No. Counry
OccuDam IPqINTI L1r KJ Phone No. ?
Power SupOlier C-Lk,-,T-, Adtlress 1.? [}Q -
? ?
lecmcal Co fiWTaELE,aTRIC SERVtCE, INCL
6528 VJEST WKE STREET C Vactor's Licednse No. ?
Maling ntltlress IComractor or OwngLimlellatronp
MInNEAPOI.IS, MN 55426 '
Autnoiizee 5ignaW:eLr""+racton0 tail lion? Pnone Number
?
- ? ,? ?? ??? 9 r?
MINNESOTA STATE BOAHD OF ELECTRICITY , THI$ INSPECTION REOUEST WILL NOT
Griggs-MlCway BIEg. - Poom S473 BE ACCEPiED BV THE STATE BOARD
1821 University Ave., 51. Paul. MN 55104 ' UNLESS PftOPER INSPECTION FEE IS
Phone(612) 642-0900 ENCLOSED
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