1480 Diffley Rd - Electrical PermitsREQUEST FOR ELECTRICAL INSPECTION 10M EB-(10001-e7
0- See instrudions for completing this form on back of yellow copy. nl-/w?2-
P 6 6 4 0 7 - -)!"Below work Covered by This Request
New A TypeofBuilding Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specify)
Comm./Industrial Furnace
Farm Air Conditioner
Other (specify) Conhactort; Remarks:
Compute Inspection Fee Below:
# Other Fee # Service Entrance Size Fee # Ciro s/Feeders Fe
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above200Amps Above 100Amps
Signs Inspectors Use Only: TOTAL ?fJ
Irrigation Booms
Special Inspection
Alarm/Communication
Other Fee
I, the Electrical Inspector, hereby
h
if Rough-in ?, Date _
y t
cert
at the above inspection has
been made. net ( Date C
o
OFFICE USE ONLY
This request wid 1a months from
'4U 'I
Request Date (?J
/ Fire No. Rough-in Inspection
wired?
i Yes ? No
El Ready N-XW,11 Notify Inspector
\` When Reatly?
10 licensed contractor 'Owner hereby request inspection of above electrical work at:
Job Addiess (Street, eoz or Route ?)?1
L1g0 Ca. K?F/ ??
" City _
Section No. Township Name or No. Range No. County
Occupant (PRINT) Phone No.
Power Supplier Address
Electrical Contractor Comps Name)
/p `/ Cgnlreetor5 License No.
Nesting Address (Contract or Owner Making Inslallation)
Authorized Sgmnc (Crntracio er ing I al lion) Phone Number
MINNESOTA STATE BOARD OF ELECTRIC" THIS INSPECTION REQUEST WILL NOT
Orlpgsl9Mwey BMg. - Room S-173 BE ACCEPTED BY THE STATE BOARD
1821 Univar9ity Ave., SL Paul, MN 551M UNLESS PROPER INSPECTION FEE IS
Phone (02) 642-OSM ENCLOSED.
/ C(? REQUEST FOR ELECTRICAL INSPECTION Ea-utwut-ua
Sae instructions for completing this form on beck of Yellow copy.
Lemma in Cj S S/C7
X' . Below Work Covered by This Request
Nay, t&Ag 4%iia Type of Building Appliances Wired Equipment Wired
Home Range ?? -n_ - Temporary Service
Duplex Water Heater Ltyhting Fixtures
Apt. Building Dryer Electric Heatr)
Commercial Bldg. Furnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm O[her Sra y) Other Ispocifvl
t or Speci y Other Other
Compute Inspection Fee Below
b Fee Service Entrance Size # Fee FeedersrSnbfeedeo. # Fee Circuits
0 to 200 Am is 0 to 30 Amts 0 to 30 Amps
Above 200 Amps, 31 to 100 Amps 31 to 100 A 's
Swimming Pool Above 100 Ami Above 100-Amts
Tra nstormers Irrigation Booms Partial,'Other Fe
Signs Special Inspection $ `-?l
R?
ks
"'a r TOTA FEE
,
Rough-in Opte I, the
Inspector, hereby
Final !ry
xte 7 certify that the above
ns portion has been
made.
This request void 18 months from
I ,is reaeesl void
18 months from 7
0 Ready Now tg Will Notify Inspec-
tor When Ready
Licensed Electrical Contractor I hereby request inspection of above
Owner electrical work installed at:
Street Address, Box.?r1 R\rtute No, City ^
,
-
action o. Township Name Or No. Range No. County -
O _ nl0JP NT)) 1 Phone No.
Power Supplier Address
p
S'?
Electrical Contractor (Com anY Na rel Contractor's License No.
Mailing Address Won tractor or Owner Making Instailano I
3 t? C?n ux ?oucu ; S51Zla
Authorized Signature (Contractor/Owner Making Installation) Phone Number
Z4 - Sias
MINNESOTA STATE BOARD OF ELECTRICITY THIS ICNSPECTION REQUEST WILL NOT
Griggs-Midway Bldg. - Room N-191 BE ACEPTED BY THE STATE BOARD
1821 University Ave., St, Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone 1612) 297-2111 ENCLOSED.