The URL can be used to link to this page

Home My WebLink AboutLA175428 _.:�,,,:5� 1 5 � r �.., '._i'•..__.�_i_.� / •`. ��' J�+tt.�t�t �rr�,��.. IlManufactured Home S�stem� Te�#Affldavi# ---�-�„ �.r._.___. Thi�form must be cnmpteted In fts entirety and be submitted at ihe 9uflding�inai inspection for the inst�ilation of a manufactured h�me. Al!tests rnust be completed and signed afF on th�s form. A certif�iCe af occupancy�witi no#be issued untii#his campieted farm is received. SYSTEMS TEST VERIFlCAT14N D�scripti�n � Dete Passed Signature of Tester� DI'�l�R 1.it11�: PursuBn!to GFR 3280.812 tb) � Date� �— `'�-- �1 `;��-- i - Print Narne d Testar and Garr�any: ��..��c. ( ��c c� a b (,` � V1tat�r Lina: Pursuar�ta+cFR 3zs�.a�z ta� oace: _ — Z �� P�nt Marrta ot Testar and Cor►�peny: � �� S • �iX�ure T�t: Pursuamto CFR 3280.61�{c} Dete: `t'=.c� � �- - .�._-_�--1 . P�int Nadr�e of Testsr and Camp�ny: �� ' rvVt._ ��_ C+��T`8�t; PuaSupnt 6o GF��ti�.705�nct It=GC 4t)e.�F �ake'/� � "�'�-� `,�� - Pdnt Nert�crF Testsr a�Cors�ty: �-�-��. �C.��. �� t�.�, Electrira�l oporatlonas: p�r,ua�m c�R .ro2 a�: -� j�; � , � Ptint NBme of Te�t�tr attd Gompany: t �~ ,� w f �-t C u� �l, �r"' ��L C��1��L.. �i6Cd'IC�1 POtel'ky: Purauan#b CFR 3285.702 Dats: � �GI o� � r : ;. -. Prlr�f Nama af Tester and C�r��tar.y: ,1 �, ,� �,'�,�' , iZ�. ' 1 (._ Ele�tricat Contlnutty: wursuent oa CFtt 32es.�o2 d�:.'�� :��.1 � � r � � Prini Name af Teater and Company: ` ; . ' � � ____--- - �- 1 V �� t�t-� ��•. � X: ! am4ke Alarn!Tl�St:Pursu�t tc t�R�28U.2G8 � t�ete: �.�._�_ Z � __ ��_ PrirK Name c�t T�ter and Carr�peny: �� c,1 ,� 5� i s � 1 c�r the abav�e syatams�etirg has been eompieted anci wes foun�t be in cnmptiar�ce w�h the provis�Ons ide�ed hx sach eyst�ecns be�st: �_� - �•�� DSte: � � 1 ~ � �� -�� -{-- �- z, `. �i".. ELECTRICAL AFFIDAVIT THIS CERTIFICATE MUST BE FILLED OUT COMPLETELY BY THE ELECTRICAL CONTRACTOR AND FILED WITH THE ELECTRICAL UTILITY BEFORE ELECTRICAL SERVICE CAN BE CONNECTED Permit#. L�4" � � � Job Site Address. � � �� C � ° , izc � .�.__ , � � � •� r .� ��l e-� � Owner � �`f �J � �1 i ��.�LL /, , < � • L�,�,��,:..`_ ��..t.C�� ;� G r_! � cv�C_ ��- Electrical Contractor/Compan Name:�� ""` Contractor License# CA Master Electrician License#: r� C C�L� �j'�-� Mailing Address (Contractst�, , pany or Owner Perf�ing Insta lation) Street Address �l '� ;-� , � - Cit � , ��./ l�f4,c1. � '� *1�. � State 't(j�, Zi Code T � ' � , , � . . � < /y !C Office Phone# ;' _� ,�� .�. ``�`"; v-� L�' Contact Phone#: -%f -�G-J- � _ Printed Name of Authonzed Indivi I� ~ � ': � � � Authorized Signature: ..r—.... AMPERAGE SIZE �.S,.L�'�-�''�� SERVICE ENTRANCE CONDUCTOR SIZE ��',,;,�� THREE PHASE SWGLE PHASE �_ DATE UTILITY CONNECTION IS REQUESTED -%��r 1 �� Lakeville Utility Providers: Dakota Electric Xcel Energy 2;28i200c