P - 80163�l 1 � dJ1 6431 University Avenue Northeast (Fr1-2) 777-70a5
FRlDLEY Fridley, Minnesota 55432 FAX (612) 571-1287
REQUEST FUR ELECTRICAL INSPECTION
"'X'" Below Work Covered by This Request
,
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Add Rap. Type ol Bu�iding Appliances Wired Equipmant Wired
Home Range Tem�rary Service
Duplex Water Heater Lighting F�xtures
Apt. Building Dryer Electnc Heat�n
Commercial Bldg. Furnace Silo Unloader
Industrial Bidg. Air Cotiditioner Bulk Milk Tank
F m O�her pec� v O�her ISpecifvl
t er Other
Compute lnsp ctron Fee Below
a Fsa SarvicsEntrsncsSi: Fee Feeders/Subfeeders p Fee Circuits
0 to 100 Am �� k 0 to 30 Am s 0 to 30 Am s
101 to 200 Amps 31 to 100 Amps 31 to 100 Am
Above 200 Am Above 100�Am s Above 100^Amps
Transformers Remote Control Circ. Partial!Other Fee
Sign Special Inspection TOTA� FEE
Remarks �. q � ` y.. �� Sp��.�
l � l r �
Rough-in D�te �, the Electriesl
. Inspector, hersby
csrtify that the nbove
Final ��..-i '��P t� h b
This rEQuest vo��d
18 nanths t�om
vvww+��.,.s.�_
This request void
18 months from
� Licensed Electncal Contrector
� Ocpep�S+t IPRINTI
Electr�cSl�o�,tractor IC
Ma�l�np Address (Co/�l�
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AuMo��zed Slpnature IC
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fire No. Rough-�n InsDect�o�
Reqwred? �Readv Nuw Q W�II Notify tnspec-
❑ Yes � No tor Whe� Ready
I hereby request inspect�on of above
9 ('elRctricsl work installed at:
C �ty
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� Pnone No.
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Contractor's L�cense No.
w Owner Makinp Instailationl
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clor OwnAt Mak�np Installauonl Pho��.gr