850 Lone Oak Rd - Electrical Permits/?/a}(Q/?9 REQUEST FOR ELECTRICAL INSPECTION ?"• o??S?
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? See instrucdons for completing this fortn on beck of yellow copy. /
R '77419 `X" Below Work Covered by This Request
ew Add Rep? Type of Building AppliancesWired EquipmentWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specify)
Comm./Industrial Furnace
Farm Air Conditioner
Other (specity) Conireclw§ Remarks:
Compute Inspection Fee Below:
# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps rl 0 to 100 Amps 2$.?
Transformers Above 200 _ Amps Abo ioo _ Amps
SIgnS Inspectors Use Only: TOTAL
'
Irrigation Booms
°
a$• 5
Special Inspection ?
AI arm/Commu nication -
Other Fee ?
I, the Electrical Inspector, hereby
tif
th
h Ft019h-'n ? o
cer
y
at t
e above inspection has
been made. Final oa
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OFPICE USE ONLY
This request void 18 months ham
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Requegt Dat -
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4 - Fi o. Rough-in Inspection
Required?
? Ready Now ill Notify Inspeclor
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( ,AYes 0 No en Ready?
kfglicensed contractor ? owner hereby request inspection of above electrical work at:
Job Addre?ox ar Route No.) Ciry
'fjGe- t?- i???
Section No.
Township Name or No.
Range No.
County
I I
OCCUpaM (PRINT)
P Phpne No. •• '
ro ssa ?.t
Power Supplier Address
Eleclrical Contractor (Canpany Name) Contrector5 License No.
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Mailing Address (COnVador o Owner Making Installaiion)
'5-56 - G `{'` 5c'. 5? Pm,,? d? -
Authorized Sgnature (Contrector/Owner Ma j Installation) Pho
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e Num6er
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MINNES A STAT BOARD OF EL&Q:?RICITY THIS INSPECTION REQUEST WILL NOT
Grlggs-M dg. - Hoom 5-173 BE ACCEPTED BY THE STATE BOARD
1821 UnNeralry Ave., SL Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phorre (612) 642-0800 ENCLOSED.
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G 03621
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Request Date ire No. Rough-in Inspection
Required?
eatly Now ? Will Notiry Inspecror
Y ? Yes ?71? When Feady?
I icensed contractor ? owner hereby request inspection of above electrical work af:
Job Address (Sireet. Box or Route Na^, ? Giry
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Section No- Towns Name or No. Range No. Gounty
_ ?
ir?
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Occu ant(PRINT) Phone No.
Power Supplier - Address
EI rical Contractor (C ny Name) Contrector's License No.
Q
' ing Address (C haCbr or Owner Making InStallali
A honzed gn ture (ContractorlOwner Makin Installa?n) Phone Number
MINNESOTA STATE BOAND OF ELECTRICIi v THIS INSPECTION REQUEST WILL NOT
Grlggs-MlAway Bldg. - Room 5773 BE AGGEPTED BY THE STATE BOARD
1827 Universlty Ave., St. Peul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone (612) 642-0800 ENCLOSED.
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R) 03621
REQUEST FOR ELECTRICAL INSPECTION
? See instmctions br completing this torm on back ot yellow copy.
"X" Below Work Covered by This Request
ee•00001 -07
e Add Rep. TypeofBuilding AppliancesWired EquipmenlWired `
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specity)
Comm./Industrial Furnace
Farm Air Conditioner
Other (specity) Contractor5 Remerks:
' ts
Compute Mspection Fee Below:
# Other Fee # Service Entrance5ize Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 700 Amps
Transformers Above 200 _ Amps Above 100 _ Amps
Sigf1S Inspector's Use Only: ?. TOTAI.
Irrigation Booms
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby Ro°9n-'" * Date
certify that the above inspection has
beenmade. Final
? Da
.? 1?U
OFFICE USE ONLY
This request wid 18 monihs irom