P - 81668FRIDLEY 6431 UNFeidley, M nnesotar55432 FAX (61� 571•1287 I l,� ���
REQUEST FOR ELECTRICAL INSPECTION
""X�' Below Work Covered by This Request
Add Rep. Type ot Building ApDliances Wired Equ�pment Wired
Home fiange Temporary Service
Duplex Water Heater L�ghting Fixtures
Apt. Building Dryer Electr�c Heat�n
Commercial Bldg. Furnace S�lo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Fdrm O�her peci v Other ISPeciryl
t r peci y ther Other
Compute lnspection Fee Be/ow
M Fse SarvieeEntrenceSize a Fee Feeders�Subfeeders p Fee Circuits
� to 1 UO Am 0 to 30 Am s 0 to 30 Am
101 to 200 Amps 37 to 100 Amps 31 to 100 Am
Above 200 Am s Above 100_Am s �'^�^'� Ahove 100_Am s
Transfor ers Remote Control Circ. �.� Partial!Other Fee
Signs Spec�al Inspectlon S
Rerr�rks TOTAL FEE
,r � �
�
Rouph-in ��1e I, th� Elsctneal
. Inapec[or, hersby
csruty thet ths ebove
F�nal �`��P inaD�ction l+as besn
• —Z —O � mads.
Th�s reQJest vo��d � �
18 nqnths from
�� LSho��
This requesl void � • 1016 4
18 mo�ths }rom �
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Request Dete�/I o� fire No. Ro�ughetl�InspQecuon �qeady Nuw0W�11 Nouty Inspec-
yes Na �or When Ready
Licensed Electncal Contractor � her�by request inspectw� ot sbove
Owner sleetrical work inatalled at: .