3893 Dolomite Dr - Electrical PermitREQUEST FOR ELECTRICAL INSPECTION
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V X"" SP,-lo,,-Y71?[?)ork Coveted by This Request
ES-00001-03
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New }td Type of Building Appliances Wirod 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 Other Specs v thnr lSpecllyl
th S Other Other
Compute Inspection Fee Below
H_ Fee Service Entrance Size Fes F tlers/SUbfeeders q Fee Circuits
0 to 100 Amps to 30 Am s 0 to 30 Am s
101 to 200 Amps 00 Amps 31 to 100 Am s
Above 200 Amps I 100-Amps Above 100_Amps
Transtormers g
Control Circ. gQ Partial:Other Fee
Signs Inspection g TOT
Remarks FEE
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Inspector" hereby
certify that the above
inspection has been
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This request void
18 months from
This request void
18 months from R1z6
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Licensed Electrical Contnctor I hereby request inspection of above
Owner electrical work installed at:
Street Address, Box or Route No. City
ecuon o. Township Name or No. Range No. 0unt4 r+a CIO
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Id Phone No.
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Power Supplier
Cr 1G' Address
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E ec tricaI C attactnr ICo : ny amen Contractor's License No.
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Mailing Address (Contractor or Owner Making Instailation)
79
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Authorize Siuna tur (Contractor Owner Making lestellaY n) Phone Number
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MIN4SOTA STATE BO;AD OIT ELECTRICITY Y THIS INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg. - Room N-191 BE ACCEPTED BY THE STATE BOARD
1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone 16121 297-2111 ENCLOSED.