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2003 Diffley Rd - Electrical Permits Request Data t?j Fire No. Roug -in Inspection R q iretl? Re Inspector C1 Reatly Now $rill h R d ? / Ves ? No rn en ea y I licensed contractor FJ owner hereby request inspection of above electrical work at: Jab Adotess ( a 0(i Street, Box or Route Not ?? -30 City ,Q- 4 / 61W Section No. Township Name or o. Range No. County 14 Occupant (PRINT) Phone No. Power Su liar `i r4 Ko7? Adtlress Electrical Contractor (Company Name) Contractors License No. 6nn-j-Ae ii . `c o Mailing Address (Contractor or Owner Making Installation) S v S" 3 44 A / 7 A a. S .s . . ve -- Author izetl Sin re (COntracmr Owner ring In lotion) JP-orae Number MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Grlgga-Mldway Bldg. - Room 5.173 BE ACCEPTED BY THE STATE BOARD 1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS Pirrone (612) 642-0800 ENCLOSED. ECTcON :ESee ristruons DUES ?Ffor`CTRoCA? bINSPof yelfow 0 7 3 0 7 X" Below Work Covered by This Request New Add. Rep.- Type of Building Applians ired EquipmentWired Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Other (Specify) Comm./Industrial Furnace Farm Air Conditioner Other(spemfy) Contractors Remarks: JIV /OD ??/,r3_ Service %yc FI P"e ] i?iYy'? Compute Inspection Fee Below: Arj C1 Repg't I. E e/o 4? # Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps to 100 Amps Transformers Above 200 Amps Abo Amps Signs Inspectors Use Onry: r.r? O7AL S ^ Irrigation Booms Ls'' V t j , t J Special Inspection AlarmlCommunication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MONTHS. I, the Electrical Inspector, hereby Rough-in t Dare i? o certify that the above inspection has been made. e Finai vo? OFFICE USE ONLY This request voirl 18 months from This raquas oid ?t 18 months fr ?? ?? A 47160 ?, Iq r 1 6 ( ('k_d, r, ( ( 0. 0e) Request Date ??- yC? D ( Fire No. Rough-in Inspection Requ ned? .?' - ?Ready Now e'O4fTl?o[ify InsUec- f Wh ., ?Yes 944. or en Ready tensed Electrical Contractor I hereby request inspection of a6oye ??Jwner electrical work installed at: Street Address, Box or Route No./? n' N/ _ City ecbon No. Township N e or No. Range No. Cow Occupant lPR TI- i l7 F4 Phone No. - - . t Tr ,>ti /k uv. ?yf z- r? r Power Supplier Address Electrical Con rector (Company Name) Contractor's License No. Mailing Address (Contractor or Owner /Making losm la i/on) 17 2 4 ) Authorizetl S atp!e nvnctod wn r Making Installacionl Phone Number ? qJ MINNE OTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bid,. - Room N•191 BE ACCEPTED BY THE STATE BOARD 1821 UNLESS PROPER INSPECTION FEE 15 University Ave., St. Paul, MN 66104 Phone 1812) 297.2111 ENCLOSED. l{ 7? a2 (?] REQUEST FOR ELECTRICAL INSPESTION EBa-v00001(-?04l4y" i ' See instructions for completing this form on back of yellow cope •/ TD? A; A71 RA "X" Below Work Covered by This Request Nev% jAddl Rep. Type of Building Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Lighting Fixtures Apt. Building Dryer Electric Heating Commercial Bldg. Furnace Silo Unloader Industrial Bldg. Ir Conditioner Bulk Milk Tank Farm other peel v omer Ispeufyl the, specify Other Other Compute Inspection Fee Below p Fee Service Entra nee Site H Fee Feodera/Subfeedera N Fee Circuits V to 2VU Am s 0 to 30 Amps u to 30.AR: >s Above 200 Amuse 31 to 100 Amps 31 to 100 Amus Signs Special Inspection Remarks $ TO FE M rNr !'LFC /I.00 Rough-in Date I t rical lnspectm. hereby cattil that the ab ve Final Date ;'-l 1! y o inspection has been made. This request void 18 months from V