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.