2120 Shale Lane - Electrical PermitsStreet Address, Box or Route No _
7 /2 o 5 a - r.e
Section No.
Township Name or No.
Range No.
Count
/
Occupant (PRINT/
Phone No.
Power Supplier
Ail
Address
3 0o o
T,Ne ,
1 Iaxc�Je l/
Contractor's License No.
q1..' ,s--
Electrical Contractor (Company Name)
C_ s -� t,0 e E P ec - 'r c
Mailing Adress (Contractor or Owner Making Insst
\ teor a�4 �,. rte;
Autho ed Signature (Co r/ er Making Installation)
PPhhonne
18
This monnths from request void' 1 ty
18 months from /j'7? O
E
1,9 '7
Request to
2 3 3'
`Licensed Electrical Contractor
❑ 9wner
MINNESOTA STATE BOARD ELECTRICITY
Griggs - Midway Bldg.— Room N -191
1821 University Ave.. St. Paul. MN 55104
Phone (612) 642 -0800
Rough -in Inspection
Reg ired? Ready Now Will Notify Inspec-
Yes ❑ No
1 hereby request inspection of above
electrical work installed at:
O
When Ready
THIS INSPECTION REQUEST WILL NOT
BE ACCEPTED BY THE STATE BOARD
UNLESS PROPER INSPECTION FEE IS
ENCLOSED.
New
Add
Rep.
"Type of Building
Appliances Wired
Equipment Wired
#
Fee
>[
Home
JZ., 60
Range
Temporary Service
0 to 30 Amps
31 to 100 Amps
3
c1; c3
Duplex
Water Heater
Above 200 Amps;
Lighting Fixtures
00
Swimming Pool
Apt. Building
Above 100 Amps
Dryer
Electric Heating
.
_
Transformers
Commercial Bldg.
Furnace
Silo Unloader
Partial/0 r Fee
Industrial Bldg.
Air Conditioner
Special Inspection
Bulk Milk Tank
TOTgL
I 1 !! tie i
Remarks - f.
Farm
OtherISpecify)
Other (Specify)
Other (Specify)
Other
Other
#
Fee
Service Entrance Size
#
Fee
Feeders /Subfeeders
#
Fee
Circuits
l
JZ., 60
0 to 200 Amps
0 to 30 Amps
31 to 100 Amps
3
c1; c3
0 to 30 Amps
31 to 1 Amps
Above 200 Amps;
f
00
Swimming Pool
Above 100 Amps
Above 100__Amps
.
_
Transformers
Irrigation Booms
,
Partial/0 r Fee
Signs
Special Inspection
�
TOTgL
I 1 !! tie i
Remarks - f.
E
379
8 REQUEST FOR ELECTRICAL INSPECTION
See instructions for completing this form on back of yellow copy.
""X Below Work Covered by This Request
Compute Inspection Fee Below
This request void 18 months from
Rough -in
Final
I. th lectricel
Inspec • >•
•ft ertify that the above
inspection has been
made.
902'18
� � ���-
No D to
-(9-q t l f
�
F ir No.
Baugh -In "Inspection Requi ed
(You must call inspector en ready)
• Yes
Ins action Other Than Rough -In
Ready Now 0 Will Notify Inspector
at ady
1 ' 14 - rinsed contractor • owner hereby request inspection of above electrical work at:
Job Address (Street, Box or Route No.) /y `
2 laO i ) La L ( � ! q ' 1�
City (�
lJl i'\ `' n u , e l_
Section No.
Township Name or No.
Range No.
County
Occupant INNT)�
Phone No.
Power Supplier
Address
Electrical Contractor (Company Name)
Harrison Electric, Inc.
Contractor's License No.
CA 00808
Mailing Address (Contractor or Owner Making Installation)
2525 Nevada Avenue North, 301, Golden Valley, MN 55427
Authorized Sign ure (Contra O eking Installation)
c-----
Phone Number
544 -3300
MINNESOTA STATE BOARD OF ELECTRICITY
Griggs- Midway Bldg. - Room S -128
1821 University Ave., St. Paul MN 55104
Phone (612) 642 -0800
THIS INSPECTION REQUEST WILL NOT
BE ACCEPTED BY THE STATE BOARD
UNLESS PROPER INSPECTION FEE IS
ENCLOSED.
New
Add
Rep.
Type of Building
Appliances Wired
Equipment Wired
Home
Range
Temporary Service
Duplex
Water Heater
Electric Heating
Apt. Building
Dryer
Load Management
Comm. /Industrial
Furnace
Other (Specify)
Farm
Air Conditioner
Other (specify)
Contractor's Remarks: �j
.\-e-' ` . ut,3
Compute Inspection Fee Below:
#
Other
Fee
#
Service Entrance Size
Fee
#
Circuits /Feeders
Fee
Swimming Pool
0 to 200 Amps
0 to 100 Amps
Transformers
Above 200 Amps
Amps
Signs
( 1\-6 ::
Inspector's Use Only:
� .J �
THIS INSTALLATION MAY BE ORE NECTED
COMPLETED WITHIN 18 MONTHS.
TOTAL
Irrigation Booms
Special Inspection
IF NOT
Alarm /Communication
Other Fee
1, the Electrical Inspector, hereby
certify that the above inspection has
been made.
Rough -in
Date
Final ai h�INI
OFFICE USE ONLY
This request void 18 months from
g �� 90 REQUEST FOR ELECTRICAL INSPECTION
1878 See instructions for completing this form on back of yellow copy.
"X" Below Work Covered by This Request
EB- 00001 -09
or/3Z 2