2975 Lone Oak Cir - Electrical Permits/p/?/f? REQUEST FOR ELECTRICAL INSPECTION
?? O? 6 See msimctions lor compleling this form on back of yellow wpy
6"X" Below Wo. k CoVBred by This Request
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e Add Repy TypeofBmitling AOPhancesWired EquipmenlWiretl
Home Range Temporary Service
Duplex Water Heater Electric Heatlng
Apt. 8uilding Dryer Load Menagement
Comm./Industrial Fumace Other (Specify)
Farm Air Conditioner
Olbet(syeafy) ConVactor's RBmarks.
Compute Inspechan Fee Below:
# Olher Fee # ServiceEntrenceSae Fee # Circuits/Feeders Fee
Swimmmg Pool 0 to 200 Amps 0 to 100 Amps OD.
Transformers Ahove 200 Amps 510 Above 100 _ Amps
Signs Inspecror9 use only ?? TOTAL SO
Irrigation Booms
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Special Inspection ?
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Aiarm/COmmunication THIS INSTALLATION MAV BE DFRM ISCONNECTED IF NOT
Other Fee COMPLETED WITHIN NT ?
I, the Elec[ncal Inspector, herehy
certi that the above ins ection has
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been made Rovgn-m
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Data
OFFICE USE ONLY ?
This requast mid 18 mon[hs Irom
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Repuest Date Frte o PIdUgh-ld InpsecLOn Peqwretl
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(YOU mvsl rail inspec InsOedion Olher Than Pough.in
0 qea0y Now ?'pJill Notily Inspeclor
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I? hce s d wnVactor ? owner here6y request inspection of above electriraf work at.
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Mai ing qaoress cOmracmr or Owner MaKing Instellauonl
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MINNESOTA STATE BOARD bFu4tLECTRICITY THIS INSPECTION REQUEST WILL NOT
Origge-Mitlway BIEg. - Roam 5413 BE NCCEPTED BV THE S7ATE 80ARD
1821 University Ave., SL Gaul. MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone(812) 642-0800 ENCLOSED.