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
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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
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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
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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.
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