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