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MINNEGASCO SERVICE INSTALLATION
Map No. Natural Gas ❑ Propane Vapor ❑ Permit No.
Municipality Minneapolis 0 Order No.
Folio No. Date Ordered E No.
Customer's Name Tel.
Installation Address Zip
Lot Block Addition
Method of Installation or Construction (including method of compaction
and excavation) will be in accordance with procedures as described in :
Minnegasco Operations Manual, Section 500, "Excavating, Backfilling and
. Surfacing",the most recent edition on file with the permitting authority.
•� ■ r+.,�a d�� �>:i° ��1 .. �_$�� 1'�5..1.. I.,'-���'�.�` °�:='
Install. ''{` £i�`� Service -` °�—Main Location
Additional I nfo. �
� Pressure Class T�
v �._"t':;;_i_:_;
Date Completed Forem�n's Name ' `
To the (City Engineer
(City Council
(Village Council
(Town Board
Minnegasco Inc. hereby requests permission to perform the work indicated
above.
MINNEGASCO, INC.
/'- /"� :%�F.,,- '�..
(Sr. Design Engineer)`/
To Minnegasco, Inc.
Permission is hereby granted Minnegasco„kmc.�o perform the wor .i�dicated
above. �� �
i l� ,i��-%`
of
,': . � ' � f - '
„ 'r
Date By ' �
(Authorized Signature)
Form 52 R 5/78
.�
MINNESOTA GAS CO.MAINTENANCE ORDER NO.
0 MAIN O SERVICE PAV.CUT NO. LEAK RPT.NO.
DATE MUNIC. RESP.ACCT.NO.
FPC-or-E NO.
LOCATION:
NATURE OF WORK
FOREIGN STRUCTURES PRESS.CL. NEW SURFACE DISTURBED
Tele � 1 � A TAP
0 Road Mix Bituminous O Dirt
Elec � 2 � C SIZE O Hot Mix Bituminous 0 Gravel
� 5 � E O Portland Cement Concrete O Oiled Earth
Light/Traf.Cable � 6 � F
O 8 O K O Roadway � Blvd. � Walk � Alley
Other
Size Disturbed
PIPE LENGTH O Same Ft. Longer Ft.Shorter Ft.Abandoned
SERVICE TAP MEASUREMENT
DATE STARTED COMPLETED FOREMAN
TRUCK NO. TOWN NO. FOREMANS P.R.NO.
To the (City Engineer
(City Council
(Village Council �
(Town Board
The undersigned hereby requests permission to perform the work
indicated above.
MINNEGASCO, INC. i
!�/"( ;.`G�r<.,v� .✓/'
(Sr. Design Engineer):i � � ��
To the Minnesota Gas Company
Permission is hereby granted the Minnesota Gas Company to perform
the work indicated above.
of
Date By
(Authorized Signature)
FORM 45A R3/78 �