P - 81476FIZIDLEY ��� � F��aiay, Minnesota 55432 FAX (612) 571-1287 ry(°'a �('� �
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REUUEST FOR ELECTRICAL INSPECTION
"'X'" Below Work Covered by This Request
Add MeD• Type ol Buildinp ApPliancea Wirsd Equ�Dmsnt Wired
Home Ra�9e Temporary $ervice
Duplex Water Heater Lightin Fixtures
Apt. Building Dryer Electric Heatin
Cortmercial Bldg. Furnace Silo Unloader
Industrial Bldg. Air Condltioner Bulk Mllk Tank
Farm
ther pec� v ther (SPecifyl
t r peci(V t er Other -
ompute lnspection fee Below
a Fse S�rviwEntrsnc�Siae q Fea feaders�Subfeedsrs !� Fes Circuits
0 to t UO Am � to 30 Am s 0 to 30 Am
101 to 200 Amps 31 to 100 Amps 31 to 100 Am
Above 200 Am Above ��—Am s Above 100._Am
Transformers Remote Control Circ. — Partial�Other Fee
Signs Special Inspection S TOTAL FEE
R ema r ks ,�,�
Rough-in Date I, th� Elsctricsl
. Inspector, h�r�by
csruty th�t th� nbovs
Final � ���P �nsp�ction haa been
meds.
This repuest void�
t8 nion�ns t�om � (;+ �j ..._
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Th�s reQueSt void 1 0 1 0 2
18 months trom ���
Request Date Fne No. Rouph-�n InsDecc�on
�,�, Required? �Ready Nuw Q W�11 NoUfy inspec•
❑Nes ❑No tor When Readv
L�censed Electncal ConVactor I h�raby request inspachon of sbove
Owner slsctricsl work inatallsd at:
Street Address, Box or Route No. C�tv
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Occupent IPRINTI Pnone No.
Powar $ plier . Addr
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Electr 1 Co�tractor o ny Namel Contractor's License No.
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Ma�11n ddress IC tractor w Owner Ma nQ Insta�lat nl
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AuMorizsd �pnature (Contractor Owner Maklnp Installatio�) Pho�e Numbe�