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1104 Diffley Rd - Electrical Permits 3 3 3 ? w a o- V o?- Ra uast Deis Fire No. Raugh-In Inapection Requiretl Inspectlon Diher Than Rough-In 3 l (YOU must wll inspector hen ready) ? Reatly Now Q Will NMify Inspedor No Ves D ate Read I?1 licensed contractor ?owner hereby request inspection of a6ove electrical work Af: ? Job Atltlress (5[ree6 Box or Po e No.) Cily ?f .9 G- ?- .4 i? 9 6 , , Seclion No. Township Nama or No. Range No. Counry / rb T?i OccuPanA(PRINT) - Phon 'No. e ?n?A !? I /? / - PowerSUpplie Atltlress / 1? Z?keo rAvrv? i/? /o N ElecMCal C nlrador (Company Name) Conlraclors license No. .9 . c GiEe ?SG?? z,v? . O 6 03 Mailing Atltlr s(COnVacmr or Owner Making Installation) ? ? ? o /?6sT . Fr= A?p, Wes Aumonzetl Signewr oniramnO wner? 1eki I ialla?ion? Phone Number / J "S? !f7'? ? MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILI NO7 Grlgps-Mldwey Bltlg. - Room 5-128 BE ACCEPTED eY THE STATE BOARD 1821 Universlly Ave., St. Paul, MN 5510i IINLESS PROPER INSPECTION FEE I$ Phone(81Y)64P-OB00 ENCLOSED. ' REQUEST FOR ELECTRICAL INSPECTION EB.oop°i.o9Q 003 3 3 3? Sae instroclions lor completing [his form on back of yellow capy. /???j??/ ? a.? fr(p "X" Below Work Covered by This Request e Add Rep. Type of Building ApplMnces VOlred Equipment Wired Home Range Temporary Service Duplex Water Heater Electric Heatin Apt. Building Dryer Load Management Comm./Industrial furnace Other S eciy) Farm Air Conditionar Otner(speciry) ConVaclors Remarks: Compute Inspection Fee Below: # Other Fae # Service Entrance Size Fes # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 700 Amps Transformers Above 200 Amps Above 100 -Am s SIgfIS Inspectors Use Only: . SO TOTAL Irrigation Booms (l(J 14 0 S ecial Inspection ?IJ ' 1 Alarm/Communication THIS INSTALLATION MA 10E RE DI CQNNECTED IF NOT Other Fee COMPLETED WRHIN 18 M I, the Electrical Inspecror, hereby tif th t th ti b i h flouqn-m ^ cer y a a a ove on nspec as been made. F'"ai oe? ' Z OFFICE USE ONLY ? This reque3t v0id 18 months hom