3010 Lunar Lane - Electrical Permitsr
I??III I IIII?I?II REQUEST FOR ELECTRICAL INSPECTIO? ?
Minnesota State Board of Electricity K
? ?°?
1821 University Ave., Rm. 12 , St. Paul, MN 55104 ?:
* 2 6 6 7 1 3 7* Phone (612) 642-0 800,5/?y?(, ???' ?
Home up ex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Hig. Equip. Water Hfr. Load Mgmt. Other:
D er Range Elec. Heat Tem . Service
"X" abo the work covered by this request. Enter remarks in this space and on the back of the white copy only.
i.?
?
Calculate Inspection Fee - 7his Inspection Request will not be accepted without the conect fee:
Other Fee # $ervice Erdmnce Size fee # Circuils/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps , p0 0 to 100 Amps , 00
Sheet Ltg./TraHic Sig. Above 200 Amps Above 100 Amps
Transformer/Generotor INSPECTOH'SUSEONLY TOT
?O
$ign/Oufline ltg. Xfmr. 0 •00 ?
Alorm/Remote Con}rol
Swimming Pool
kd Ihe eIe ' Ilafio tri ein on ihe datet sMted mtls
I he
b <erH ih
t I ins e
Irrigution Boom re
a
c
Rough-In e
Special Inspedion -02
Invesfigative Fee Finol
.
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
I-,42 7 3
- 2 5 3 5? ?'? ?is requesl vald IB months from ralidalion dafe pnnted in this bax
S V+ H
.
?
.
?
i ? ? 1 da7
PLEASE PRINT OR TYPE ?O I
Requasf Date ` Rough-in mspedion requiredd Yes ? No Inspedion Other Than Rough-In; Q Ready Now WII Call
5 ` 7- (You musf mll Ihe inspador when ready) Date Rwdy:
I, 19 licansed conirocFor Q owner here6y request inspection oi fhe above electricvl work at:
Jo6 Pddress (SfreM, Box, or RoWe No.)
3or? &
L City
E Zip Gode
ss? z/
)Kur
a?? A 4-',
Sedion No. Township Name or No. Range No. Fre No. Couny
Ottupanl
S
'
?
? Phone No.
/ f re S
r
d G H Y"? I
S
1 5Gl7 .?s
Power $upplier Addreas
Electric? on atlor (Compo y /yame) ?
? Commdor license No. ' Master Lic. No. (Plant Elect. Only)
?
i?+/'y`? K?
Moiling Address (Canlm r or Owner Pedorming Insbllotion
.D. ?X lTT6 l?f??s??'? Q
/''?h 55337
Authorized Signotu , onlmctor or Owna? Pedormi
1
'
??? P.hone No.
S??Y-?o360
.,?
0
? .
EB-000010T/95 STATEBOApDCOW-SEEINSTAUCTIONSONBACKOFYELLOWCOPY
`??I IIIII ? II IIIII REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
?? MN 5s?oa
1821 ? 5
0 7 3 2 S 3 5 * Phone (612)642-0800 ?,?-'-/y6
Home Duplex Apt.8ldg. Ofher: New Addn
Commercial Indushial Farm Remod Re air
Air Cond. Htg. Equip. Water Hfr. Load Mgmt. Other: ?
D er
Range
Elec. Heat
Temp. Service t
"X" above }he work covered by fhis reqvest. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspecfion Request will not 6e accepted without fhe correct fee:
Olher Fee # $ervice Entrance $ae Fee # Circuits/Feeders Fee
Mo6ile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TO , l
Sign/Outline Lig. Xfmr. ?
,?y vl
Alorm/Remote Control O
Swimming Pool
d the eleclnml inslal a n ed hercin on the doles stated
ed
I h
b
fi th
t '
IRi9tlfion BOOm ere
ar
a
s
e
Rough-in
7 Dafe
Special Inspedion 14
Investigative Fee F' Da
THIS INSTALLATION MAY B ISCONN TED IF OT COMPLETED WITHI 1 MO T .
2 6 6- 713
T This request void 1 B months !mm validefion dole pnnted in Pois box. ?
OFFl E USE ONLY
yf q/9 ? ?'S7a
PLEASE PRINT OR TYPE ? o( ?yA
Reque Date Rough-in inspetlion reqvir Y
(You must <all ihe inspedor when es ? No
ady; Inspecfion Other Than Rough-In: [] Ready Now Will Call
Daie Ready:
I, licensed conhactor Q owner hereby request inspection of ihe above electrical work at:
Job dress (Sireet, Box, or Route Na) Ciy 2p Coda
G? !! G
SecFOn No. Township Name or No. Rolge No. Fire No. Co ty
Occu ant , • Phone No.
P r Svpplie? `
f/ C- ? .
?? Address OO ?p7 ,S' • ?
/ Gr ?.soa
Eleciri onlmdor (Compo pfiamgl nlmdor license No. Moshr L c. No. (Plant Elect. Only)
oiling Addrass (Conhacfor or Owner Pedortning Instollafion)
? !?
?
Z??'
Authorized Signolure (Contraclor ar O r Pedo 'in nslollaNon) Phone No. ?{h
EB-00001A-10 6/95 XSTA'FE BOApD COPY • SEE INSTRUCTIONS ON 9ACKOF YELIOW COPY