P - 82437FIZIDLEY 6431 UniFeidley, M nnesotar55432 FAX (612) 571•1287
REQUEST FOR ELECTRICAL INSPECTION
"'X"" Below Work Covered by This Request
Add pep. Type ot Bullding ADD��ances Wired
Home Range
Duplex Water Heater
Apt. Buf Iding Dryer
Commercial Bldg. Furnace
Industrial Bidg. Air Conditioner
Fdfm O�her pec� v
� t r peci y t er
Compute lnspection Fee Below
I�`i��
Equipmant Wired
Temporary Service
Ughting Fixtures
Electric Heat�ng
Silo Unloader
Bulk Milk Tank
Iher l5pecifvl
Other
a Fss SsrvicsEntrencsSizs M Fea Feeders/Subfeeders p Fee Circu
0 to 1 UO Am s 0 to 30 Am s � to 30 Am
__ 101 to 200 Amps 31 to 100 Amps 31 to 700 I
1 I a�gns
Remarks ��` �
Rough-in
F�nal
Above 100_Am s Above 100.
Remote Control Circ. �� Partial!Oth
ipecwal Inspection Sld�Qd
TOTA� FEE
-�- . 1, the Electncal
. Inspsctor, hsrsby
c�rUfy tMt ths nbove
�^f�P�r inaD�chon has besn
.aGp "�� rneds.
TMS repuest vo•�d �
18 nqntbs from
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This «a�es, �a,d � � �� 1015 6
18 months twm ��
V
Request Date Fire No. pequhe�n�InSDect�on �qead� Now Q W�II Nouf� tnspec-
"�4—(/0 ❑Yes ❑No �o� Whe� Ready
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Licensed Electncal ConVactor 1 h���by r�qwat inspect�on ol above
❑ Owner slsctricsl work installsd at: