680 Diffley Rd - Electrical PermitsThis
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Licensed Electrical Contra ctor I hereby request inspection of above
? Owner electrical work ins talled at:
Street Address, Box or Route No. -D ( fl
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Sedition No. Township Name or No. Range No. Cou
Occupant (PRINT) Phone No.
ower Supplier Address
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Electrical Contractor ( ompany Namel
Contractor's License No.
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Mailing Address (Contractor or Owner Making Irreiailatim-)
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A uthoriz etl na[u ICOnlyd ctor? r Ma k' Installation) Phone Number
MINNESOTA STATE BOARD ECTRICITY THIS INSPECTION REQUEST WILL NOT
- RoaN-t 91 BE ACCEPTED BY THE STATE BOARD
Griggs-Midway Bidg. UNLESS PROPER INSPECTION FEE IS
1821 University Ave.. St. Paul, MN 55104
Phone (6121297-2111 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION JIM ER-00001-04
004 ^ See instructions for completing this form on back of yellow copy.
L 2g6 -,X- Below Work Covered by This Request
Fdd Rep. Type of Build in9 Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Lighting Fixtures
Apt. Building Dryer Electric Heatin
Commercial Bldg. Furnace Silo Unloader
Industrial Bldg. Air.Conditioner Bulk Milk Tank
Fa rill !her peo y Other (S pecily)
uu Other Other
ompute Inspection Fee Below
M Fee Service ize k Fee Fenders/Subfeeders p Fee Circuits
0 t 00 0 to 30 Amps _SM 0 to 30 Am s
Above 24-Amps 31 to 100 Amps 31 to 100 Am
Swimming Pool Above 100-Amps Above 100_Am s
Transtormers Irrigation Booms Partial-'Other Fee
Signs spection
Special I
s/
TOTAL
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Remarks 1T,
Rough-in Dnt
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[rP' Inspector, hammy
ceruly that the ,have
Final D'? tee inspection has been
made.
This request void IS months from