P - 79682FRIDLEI( on�� uniFeidley, M nn sotar55432 FAX (612) 571-1287
REQUEST FOR ELECTRICAL iNSPECTiON
'X'" Below Work Covered by This Request
Add Rsp. Type ol Bu�lding Appliances Wired
Nome Range
Duplex Water Heater
Apt. Building Dryer
Commercial Bldg. Furnace
Industrial Bldg. Air Conditioner
Farm o�ne� oec� v
1 r Uecify Other
'ompute lnspection Fee Below
a Fse Ss�vicsEntrancsSize u Fee Feeders�Subteeders p
Otol00Ams Oto30Ams
101 to 200 Amps 31 to 100 Amps
Above 200 Am s bove 100�Am s
Transformers emote Control Circ
�kS
1-i(7
ipecial Inspection S
i :; � '�l �
Equipment Wired
Temporary Service
Lighting Fixtures
Electr�c Heat�ng
Silo Unloader
Bulk Milk Tank
O�her ISDecilyl
Other
Fea ci�����g
0 to 30 Am
37 to 100 Am ,
r--� Above 100_�
Partial!Other F
n� TOTAL FEE
uace �, the Electricsl
Inspector, harsby
Final ""�� p��P csrtl}y thet ths ebovs
� inspection has besn
i � z�'b m�ds.
This reQueSt vo��d .
18 nionths from
ra�-�+�_� ___... �---'-----'----------------�._..�_. _
Th�s request void n�//��� 1 0 1 9 3
18 montl�s from �� �O ��
I\.i �J r
Fequ t Oate P�re No. Rouph-m tnsoecNon
Requiretl? �Ready Now Q W�11 Not�fy t�spec-
❑Yes �No tor When Ready
�Licensed Electrical Co tractor 1 hereby request inspect�on of ebove
Owner elsctricsl work ins�alled at: