2965 Lone Oak Cir - Electrical Permits--i A7 a t7
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8 II I III IIII) REQUEST FOR ELECTRICAL INSPECTION
Minnesoffi State Board of Elactricity
1821 U( ive; ity Ave., Rm. 5-1.28?? aul, MN
4* Phone 612 642-0800 ,T?/O ?
Home Duplez Apt Bldg. Other: New A dn
Commercial Indushial farm Remod Re air
Air Cond. ' H}g Equip. Wofer Htr. Load Mgmt. Other:
Dryer Ran e Elec. Heat Tem . Service
"x" a6ove the work covered 6y fhrs requesf. Enfer remarks in thts spoce and on the back of the whife copy only.
Calculafe Inspection Fee - This Inspedron Reqvest wdl not be accepted withoW the comecf fee:
Olher Fee # Service Enkance $rse Fee # Circvih/feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 7 00 Amps
$freet Lig./rraHic Sig. Above 200 Amps A6ove 100 Amps
Transformer/Generotor INSPECTOH'SUSEONLY TOT
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Sign/Oufhne Ug. Xfmr.
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Alarm/Remote Control
$wimming Paol I herob <eM ihat I ms Med Ihe elednwl inslallahon deuribed herein on 1he dak e?e?
Irri9afiOn Booro Raugh-In Dot?
$peaal Inspection
Investigafive Fee
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TNIS INSTALLOTION MAV BE ORDERED DISCONNECT NOT E U WISHIN 18 MONTHS.
2 p?? 86,8
« ? OFMCf- E NLY This reqvest mid 18 montlis hom validohan dok pnnted in this bon
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PLEASE PRINT OR TYPE .
Psq est Dak Rovgh-in impecnon r ired2 J?J,.YCS ? No Inspedion 01her Than Rough-ln ffl Ready Now JI Coll
?.- -. 6 IYou m?st call Ihe inspeclor when rmdy) ob Rmdy
I, Lo licensed confrador ? owner hereby requesf inspedion o}he a6ove e ri ? ?
Job Pddress (Skeep Bor, or Route No I Ciry
29457 LdN l ?
Setlion No. Tawnship Nome or No Ronge No. Fire No Co ?
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Ouvpam ?J , rcl
ab a 7?+r Phone No
PowerSyppGerC_ fddress
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Eleanml Contmclor (Compony Name? lmdor Lcense No
D F? cT. fFCCon??9 612o 7 Mosler ha No. (Planr Eletl Dnly)
Mailiig Pddme (Coniroqor or Owna PaAorming Inemllvhon)
Authan 5 nomm (CoMmdor o? Owner Perfarming Insrollanonl Phone No.
EB-00001A.10 6/95 STA MDCOPY-SEEINSTi1UGTIONSONBACKOFYELLOWCOW