3869 Dolomite Dr - Electrical PermitsREQUEST FOR ELECTRICAL INSPECTION EB-00001-03
Sen instructions for completim s form on back of yellow copy. ?y
Y `3`5385?
X"" 621ow Work Covered by This Request 101 30 ( 0 a
ew Add Rep. Type of Rullding Appliances Wired Equipment Wired
Home ?Iz Range Temporary Service
Duplex Water Floater Lighting Fixtures
Apt. Building Dryer Electric Heating
Commercial Bldg. Fumace Silo Unloader
n(lustrial Bldg. Air Conditioner Bulk Milk Tank
Farm O n the, IS nerifvl
t ier Sped lv O Othor
Compute Inspection Fee Below
9 Fee Service Entrence Size 9 Fee Feeders LSubfecdele 4 Fee Circuits
0 to 100 Am s 0 to 30 Amts ';° 0 to 30 Amps
101 to 200 Amps 31 to 100 Amps 31 to 100 Am
Above 200 Amts Above 100 Amps Above 100_Arri
Transformers Remote Control Circ. Partial/Other Fee
Signs Special Inspection s `?
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Renurrks n 15-71 1 io L E.-
Rough-inl t t Date
U ?a Eletl
Final y hat the aybove
)?'''T ection has been
/ / ? l ? 1 /?/- e.
This renuest void
to ..,....mom r......
Ais request v.,d S//
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,'Request Date .? Fire No. Rough-ii Ins oeclion
Reuu ned?
?Readv New 11 Notify
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es ? No en Ready
or
ad
Licensed Electrical Contractor I hereby request inspection of above
? Owner electrical work. installed at:
Street Address, Box or Route No.
?? /?c?lUmr??, ,??E. City
c? A?
ecvon u. lowaSruP Name or No. Rnnge No. '/ntt'
(PRINT)
Occu annt Phone No.
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Power Supplier Address
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EI trlcal Contactor {LOmpeny Num.) Contractor's License No.
>?l(AC73-
Ma(Iln duress
(C ontraumr or Owner Making Ins tailation)
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A uthoriz tore IContr for ,Owner Makinq Installation)
P
ho Number
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MINNESOTA STATE BOARD Of ELECTRICITY - THIS INSPECTION REQUEST WILL NOT
Griggs.Midway. Bldg. ^ Rgaa N-181 BE ACCEPTED BY THE STATE BOARD
i e21 University Ave., St. Paul,'WN 551" UNLESS PROPER INSPECTION FEE IS
pw....e fall »7_1111 ENCLOSED.
^REQUEST FOR ELECTRICAL INSPECTION
Tt }(? (}( q See instructions for compleling form on back of ynllow cop V.
"X"" Below Work Covered by This Request
l: E8-0000111-03
Ne, Add Rep. ' hypo of Building Appliances Wiretl Equipment Wired
Home Range Temporary Service
Duplex Water Heater Lighting Fixtures
Apt. Building Dryer Electric Heating
Commercial Bldg. Furnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm r Vl? thcr Isuncifyl
t tei specify
r,r
r Olher
Compute Inspection Fee Below - '
N Fee Service Entrance Size p Fee Forders/Subfeed.r, 4 Fee Circuits
I 0 to 100 Amps 0 to 30 Amps PTO 0 to 30 Amps
101 to 200 Amps 31 to 100 Amps 31 to 100 Amps
Above 200 Amps Above 100Amps Above 100_Amps
TranSternters Remote Control Circ. I Partial/Oth
Signs Special Inspection g E
T
7
5
Renunrks ?t { ?? ,?Q .
OTAL F E
,
Rough-in L I 4. Data
l1'(?/ 1 L- , ???? a Electrical
Inspect hereby
certify that the above
Final t. ( Dnte LL f_ action has been
r ?Q ??O made.
This re ev1 void
18 months from
This regoest void -7
X18 months from
s--2.5 3Z 4
L )s, P/I 3cta?k (l 3'`d 3n10 g
\/S2-Sb
Roque Unto Fire No. Rough-in Inspection
R oared?
os ?No
Ready Now WIII Notify Inspec-
?
or When Ready
Licensed Eleatncal Contractor I hereby request inspection of above
Owner electrical work installed at:
Street Address, Box or to No. Ci
9 &n
eCUOn o. Township Nome or No. Rnnge No. County
I or (PRINT)
(
_^ Phone No.
d
l e-
Pnwcr $uppli
C44 (p Address
EI ical Contractor (Cum Ay Name) _
' Contractnr's.Licens'e No.
Pi 0?{1LoO3-`?
Mailing Add ss (Contractor or Owner Making Installati onl
Authorized Signature
ntracto nor Making Installation) Phone Numher
4 - 9
MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg. - Room N-191 BE ACCEPTED BY THE STATE BOARD
1821 University Ave.. St. Peat, MX 55104 UNLESS PROPER INSPECTION FEE IS
... 111111517-11111 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION
T Rv3 8 4 ? Soe instructions for completing form on back of VeI low copy.
ow;tlObrk Covered by This Reqouuest
w.er E13-00007-03
3vJo2?
New Add Rep. Type of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Lighting Fixtures
Apt. Building Dryer Electric Heating
e Commercial Bldg. Furnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm 0t n e the, (Speclly)
Other ncci(y O(I 0thor
Compute Inspection Fee Below
P Fee Service Entrance Size rs a Fe Circuits
C}.,? D to 10Am 5 3 r1
-10 0 to Am
101 to 200 Amps I ,? ._r 31 to 100 Am s
Above 200 Amps =
mps Above 100_Amts
Trarufonner53 !. t. irc. ,$ Portia l.'Other
i;gns fl \ r`"
n
$ /
TOTA
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Remarks
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$3 L FE
.
5
Rough-in
Final (
? Ua/te e (?
l ?,'t `0
aJt,
15'k the Electrical
Inspector, heraby
certify that the above
made ection has been
This request void
18 months hpm