P - 82500C`�O� Municipa! Cen2er �a ��
FRiDLEY 6431 UniFeidley, M nnesotaf 55432 FAX (672) 571-1287
REQUEST FOR ELECTRICAL INSPECTION
"'X'" Below Work Covered by This Request
Add Rep. TyDe o1 Building Appliances Wired
Home Range
Duplex Water Heater
Apt. Bui Iding Dryer
Commercial Bidg. Furnace
Industrial Bldg. Air Conditioner
FdfR1 � Iher peu v
t r pecify thgr .
Compute lnspection Fee Below
k Fse SsrvicsEntraneeSizs p Fee feeders/Subfeede�s p
0 to 1 UO Am s 0 to 30 Am s
101 to 200 Amps 31 to 100 Amps
Above 200 Am s Above 100_Am s
Tran ers Remote Control Circ.
Sign peciallnspect�on S
� �� `.� f ) �; � �Cl1�S'��.�7D �
f ma I
This request va�d
18 rtionths from
1V'ui
Equ�pmenc Wired
Temporary Service
Lighting Fixtures
Electnc Heating
Silo Unloader
Bulk Milk Tank
�her l$p2c�fy�
Fee Circuits
� to 30 Am �
31 to 100 Arr
�D� TOTAL FEE
te
1, ths Electneal
Inspector, h�rsby
csrtffy that ths nbove
�P insDect�on Ass bsen
-�--�' d mede.
This ,�q�e5► �a,d 10 i 61
18 months from �� ��� nOf D�
C�f
Re4ues/� O �O . Fire No. peQ ired?Insact�on �Readv Now Q W�II NoUfv InsPec-
3 �es No tor When peady
�,,--,, //Llcensed iC(j, I�O�»ctor � h���by r�quest inspechon of abow �
�Owner �� + V alsctrical work inatalled at:
Street Addr ss, Box or Route N Citv
'�t3�0 � � _ G-�t ��� �
� Occupent
Elect��cal C
Ma�l�np Add
1 pne ture
ICompanv Namel
tll���
1Sactor or Owner Maklnp Instaita�
(C�or Owner Mak�np Instal
C�
Pnone No,
Contractor's License No.
umbe�