810 Lone Oak Rd - Electrical permitsREQUEST FOR ELECTRI, ',AL I[VSPECTION „ Ee-00001-04
' See instru[tions tor completing this lorm on back of yellow copy. 959 &
C 32179 "x" 8elow Work Covered 6y This Request
NwA Add ReP. Typa oi BuilAing Apptiancae Wired EquiVment Wired
Home Range Temporary Service
Duplex Water Heater Lightin,y Fixtures
ApL Buildfng Dryer Electric Heatin
Commercial Bldg. Fumace Sllo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tenk
Farm Oihrr peci y Otner ISPerifyl
t er Spc Other Other
om ute lnspection Fee Bel ffw 07 0-e-1
k Fee Service EnlrenceSize tt Fee Feeders/5u6feeders b e Circuits
0 to 200 qm s 0 to 30 Am s to 30 Am s
Above 200 qmpy 31 to 100 Arnps 37 to 100 Am s
Swimming Pool ' Above 100_Amps Above 100_Amps
Transformers Irrigation Booms p Partial-'Other Fee
Signs Special Inspection A
RBrrNrks 537, TOTA EF.,?? ?
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flouBh-in _.' ? Date
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Inspector, ereby
certif
thxt the ab
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ove
insDection hes been
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This request vold 18 moMha trom
This request void 78 month5 from
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Re esl-i?ate-• Fi e No. Rouph-in Inspection
RequireA?
eady Now Q W, II Notify Inspec-
G Yes ?No tor When Ready
Licensed Electncal ContrACtor 1 hereby request inSDection oi eboVe
Owner '- elemrical work installad at:
Street Address ox Rout No.
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vle City
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ecLOn o. 7ownship Name or No. Range No. County
Occupant (P,O'?Jj) ?? 0 • "
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Pawer Supvlier _,s
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Address
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Electrical Contractor IComp?My/Name1
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?,i,GOwCs? No.
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MailinB AdJress (ContraG[or or Owner Making Instailation) ?
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Au[horized SiBnature (Co r tor/Owner king Installation) Phone Nu ber
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MINNESOTA-STATE BOAflD OF ELECTRICITV
Griggs•Midwey Bldg. - Room N-191
1827 UniversitY Ave., St. Paul, MN 55704
Phone 16121 297.2111
THIS INSPECTION REQUEST WILL NOT
BE ACCEPTED BV THE STqTE BOAHD
UNlESS PpOPER INSPECTION FEE IS
ENCLOSED.