1470 Diffley Rd - Electrical PermitsMinnesota State Board of Electricity
1954,I,Iniversity Ave., St. Paul, Minn. 55104-Phone 645-7703
REQUEST FOR ELECTRICAL INSPECTION
CHECK BELOW WORK COVERED BY THIS REOUEST
/aSo94
5262
Type of Building N .Add. Rep. Check Appliances Wired For Check Equipment Wired For
Home Z ? ? Range ? Temporary Wiring ?
Duplex ? ? ? Water Heater ? Lighting Fix tares ?
Apt. Bldg. ? ? ? Dryer ? Electric Heating ?
Commercial Bldg. ? ? ? Furnace ? Silo Unloader ?
Industrial Bldg. ? ? ? Au C n _ Bulk Milk Tank ?
Farm ? ? ? List 1" List
Other El El El ?ehe 91 ?1 Reheers
COMPUTE INSPECTION FEE BELOW mr Uid
Service Entrance Size: # Fee Feeders&Subfeeders: # Fee Circuits: # Fee
0 to 100 Amps. 0 to 30 Amperes 0 to 30 Amperes
l0l to 200 Amps. 31 to 100 Amperes 31 to 100 Am res
Above 200 Amps. Above 100 Amps. Above 100 Amps.
Transformers Remote Control Circ. Partial or other fee
Signs Special Inspection Minimum fee $5
Remarks TOTAL FEE
1, the Electrical Inspector, hereby
(Final)
This request void 18 months from
been made-.
s,This request void 18 months from u/! -Od / -A SoP
?a 5262
rDate of this Request /? - a -
1, as ? Licensed Electrical Contractor weer, do hereby request inspection of the above electri-
cal wiring installed at:
Street Address or Route No. ,- --*-' 9
Section Township
Which is occupied by
Is a roughin inspection required on this job? No D Yes V Ready Now ? will can C8'
?.SLc--oa yf
Power Supplier?Addr . - - -- - =
•.- ego-.-?
Electrical Contras Contractor's License No. _
(company Name)
Mailing
Authorized
Range Countvaa Z-"
Installation)
WARD OW State ifThis inspection request will not be accepted by the
UT W State Board unless proper inspection fee is enclosed.