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3877 Dolomite Dr - Electrical PermitsREQUEST FOR ELECTRICAL INSPECTION «A E13-00001-03 See instructions for completing this form on back of yellow copy. T 79917? X" Below Nark Covered by This Request .3O-7 I New Add IR Type of Building Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Lighting Fixtures Apt. Building Dryer Electric Hearin Commercial Bldg. Furnace Silo Unloader Industrial Bldg. Air Conditioner Bulk Mi Ile Tank Farm Other Speo Y Other (Specify) [her Spomfy Other Olhln Compute Inspection Fee Below p Fee Service Entrance Size N Fee Feeders/Subfexders p Fne Circuits 100 0 to 100 AIT1 1s 0 to 30 Amps 0 to 30 Am 101 to 200 Amps 31 to 100 Amps r00 31 to 100 Amps Above 200 Amps Above 100Amps Above 100-Amps Transformers Remote Control C1 rc. Partial,'Ot r ee Signs Special Inspection sC?r 0 T /JQ Remarks ?Vr?' OTAL E l Rough t Date _ I, the Electrical Inspector, hereby certify that the above Final T ection has bnen l?z? 3 made. This re e.r vnid 18 months from ?-2???- . ?-??- ? 4 '???%,; . request Vold/ZS L ?l? jZ) 13 Iy/ f 3Q7 y .\ /! months from l 79917 ?r a? hc?l ??a ?sol oc? Roqu{n,?s [9atg,? 60 q S J Fire No. Reugh-in InsPeclion Requ retll ?Ready Now ? Will Notify Inspec- l C J ?Yes ?NO ur When Ready Licensed Electrical Contractor I hereby req oast inspection of above Owner electrical work installed aL Street Address, Box or Route No. Cit 38`1'??-`l?9-g1•?3 ???.?o ecuon n. Township Name or No. Range No. County Occup4nt(PRIN Phone No. P er 5 ppil? Adtlress ?-` Eleciri cal Conti ctor ICuor Y Name C tier Cs Licensy No. A. 0`7 ((f ress (Contractor or Owner Making Installation) Mailing Ad d a ( i Authorized Signature (Contractor/Owner Making Installation) Phone Number ?,35ss MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room N-191 BE ACCEPTED BV THE STATE BOARD UNLESS PROPER INSPECTION FEE IS tB--- It II IQV AVa.. St Paul, MN 55100 ENCLOSED. OF...... (Ri JI JY]_Jtlt