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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