P - 83829'I FIV� Fridley, Minnesota 55432 FAX (6
REQUEST FOR ELECTRICAL INSPECTION
'"X'" Below Work Covered by This Request
Add Rsp. Type oi 8uildiny Apvliances Wired
Home Range
Duolex Water Heater
industrial Bldg.
Farm
t er uecify
ite lnspection Fee Below
Fse SsrviceEntrenceSize
0 to 1 UO Am s
101 to 200 Amps
Above 200 Amo:
rks
rin
final
Th�s reCUest void
18 �anths f�;!- �
� � (�.",�
Th�s request void �
18 months from
rurnace
Air Conditioner
Other pec� v
;ques[ uace r�re
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Licensed Electncal Contractor
Owner
1
Fee Feeders�Subfeeders b
Oto30Am s
31 to 100 Amps
Above 100_Am s
Remote Control Circ.
Special Inspection S
■
�
Equipment Wired
Temporary Service
Lighting Fixtures
Electric Heatinp
Silo Unloader
Bulk Milk Tank
ther ($p2Cify)
Other
ate
)i+IP.
� Z�
Fee Circuil
0 to 30 Am
31 to 100 A
bove 100_
artial�Othi
l'� TOTAL FEE
I, the Electricsl
Inspector, hsreby
certlly that tha nbove
inspection has bsen
made.
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�6/
a3S od
Rouph-in InsPect�on
Required? �Ready Nuw Q W��I Nouty InsDec-
� yes � Na ror When Ready
I heroby request inspectlon of above
slsctrical work inatallsd at:
25� (��