P - 84512CI�O�' Municipal Center ����
F(ZlDLEY 6431 University Avenue Northeast (612) 777-7885
Fridley, Minnesota 55432 FAX (612) 571•1287 � O O� O
RE�UEST FOR ELECTRICAL INSPECTION
""X'" Below Work Covered by This Request
Ad ep. Type ot Bu�ldinq Appliancea Wired Equ�pment Wired
Home Range Temporary Service
Duplex Water Heater Lightin Fixtures
Apt. Buiiding Oryer Electric Heatin
Commercial Bldg. Furnace Silo Unloader
Industrial Bidg. Air Conditioner Bulk Milk Tank
F3rm � ther pec� v ther (Specityl
t r yeci(y ther Other �
ompute lnspection Fee Below
tJ Fse SsrviceEntrsnc�Size p Fee Feeders�Su6feedars p Fee Circuita
0 to 100 Am 0 to 30 Am s � to 30 Am
101 to 200 Amps 31 to 100 Amps 31 to 100 Am
Above 200 Amps Above 100_Am s Above 100_Amps
T ans ers Remote Control Circ. --^ Partial�Other Fee
Signs Special Inspection S C•Z,k
y.. ,1 ']y/��/, �� TOTAL FEE
Rema r ks C� _/ N� / C_ (�-! /�,/ Y�"i
r
R rt. ►, Date �, the Electrical
inavector, heroby
csrtify that ths ebovs
Final � �^�P �. inap�ctioa hsa been
msde.
� r i �:.��..���.��-_-���_��..���.�..��.�.��..� � ��....��....��-��'
Th�s request void �\ ,^� � � 1 ��
18 months from /�p�;
Request Date F�re No. Rouph-�n Inspecc�on
/ ReQuued? �Ready Nuw Q W�n Nouf� Inspec-
/ � ❑ Yes � No cor When Ready
� Ucense Electr cal ConV�ctor 1 hereby request inspection of above
�Owner slsctncal work inatallsd at:
Street Address, Box or R ute No. Ci�v
�i',S �C2 � S� F'��
Occu nt IPRINTI Pnone No.
� ���� �7�2 - / 7D
Power pli . Address i �,+ /�
5 1 ►1l c� �J t��� Ein
Electrical Contractor ICompany Name) Contractor's L�cense No.
����
Ma�llnp Address (Contr ctor p� Owne� Makinp Instaile ionl
�S�( (� � �f� �� �
AuMo�� S�pnature ( optr ctor Owner Mak�np Installation) Phone Number
,.� S7r� ' �0 0
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