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1490 Diffley Rd - Electrical PermitsMinnesota State Board of Electricity 1994 University Ave., St. Paul, Minn. 55104-Phone 645-7703 REQUEST FOR ELECTRICAL INSPECTION CHECK BELOW WORK COVERED BY THIS REQUEST /07V 5266 Type of Building New Add. Rep. Check Appliances Wired For Check Equipment Wired For Home ? ? Range ? Temporary Wiring ? Duplex ? ? ? Water Heater ? Lighting Fixtures ? Apt. Bldg. ? ? ? Dryer ? Electric Heating ? Commercial Bldg. ? ? ? Furnace ? Silo Unloader ? Industrial Bldg. ? ? ? Air Conditioner ? Bulk Milk Tank ? Farm ? ? ? List List Other - O ? ? op HerersI 0p Herers? COMPUTE INSPECTION FEE BELOW Service Entrance Size: # Fee Feeders. Subfeeders: # Fee Circuits: # Fee 0 to 100 Amps. 0 to 30 Amperes 0 to 30 Am eres 101 to 200 Amps. 31 to 100 Am eres 31 to 100 Amperes Above 200 Amps. Above 100 Amps. Above IOQ__Amps. Transformers Remote Control Circ. Partialor otherfee G Signs Special Inspection Minimum fee $5.00 , Remwks kN TOTAL FEE -1/7/e ?r I, the (Final) ffi" This request void 18 months from certify t the aJ? v ns Lion has been made. / Date 71i ,. ,(ate ?-/?'tJ(J ,Ais request void 18 months from /02 d ?S R - 5266 Date of this Request `? l a 1, as ? Licensed Electrical Contractor Owner, do hereby request inspection of the above electri- cal wiring installed at: Street Address or Route No. Section Which is occupied Name or u; p t) Is A roughin inspection required on this job? No ? Yes Ready Now ? Will Call Power Suppli? / Addres„S? , f?' _i4Z Electrical Contrl? - - -?? Contractor's License No. G Mailing Address l p r? ?> ,4 Authorized Signature Phone Nowr?_4r 7 (Electrical Contractor or Owner Making This Installation) SI f1;? (j 51 ? BOARD LS, U j,( (r'/Q} ??1Q This inspection request will not accepted the ?J ( State Hoard unless proper inspection fee is enclosed.