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P - 82614�"� �� 6431 University Avenue Northeast (�64g) 777-7885 r /, "7 FRIDLEY Fridley, Minnesota 55432 FAX (612) 571-1287 �� 4 1 REQUEST FOR ELECTRICAL INSPECTION '"X'" Below Work Covered by This Request Add peD� Type ot Building Appliances Wirad Equipment Wired Home Range Temporary Service Duplex Water Heater Lighting Fixtures Apt. Building Dryer Electric Heat�n Commercial Bldg. Fumace Silo Unloader Industnal Bidg. Air Conditioner Bulk Milk Tank Fdrm Other pec� v O�her iSoe� itvl t r uec�fy Other OthPr Compute lnspectron Fee Below ft Fse ServiceEntrenceSize p Fee Feeders/Subfeeders p Fee Circuits 0 to 100 Am s � to 30 Am s � to 30 Am s 101 to 200 Amps 31 to 100 Amps 31 to 100 Am s bove 200 Amps Above 100_Amps Ahove 100_Am�s Transformers RemoteControl Circ. Partial�Other Fee s Spec�al Inspect�on Remarks S�p.Oo TOTAL FEE �.t1� � C �%O Rough-in Date � I, the Electr�cal Inspecto�, heraby certify that the ebove f�nal �`�«' i�specfion hes baen _. � /� meds. Th�s reQUest vo�id � -__ 1_8 _K2nths_f..�_=_______.___..�___^_____.___..__�_==-�s� , ��C� � This reQues�t�,vo� � // � .� t /' � 18 mpnths f�,rt�.�� m. . �� i � � ryr \J f � �1 Request Date fi�e No. Rouph-in inspectwn �� Aequired? �Ready Nuw Q Will Nolify Inspec- O� ❑�es �No tor When Feady ❑ L�censed Electncai Contractor I hereby requast �nspechon of above Owner alectrlcal work installed at: Street A�tdregs, Box or Ro te No. Gty . / �-� � D /�a p � Occup tIPRINTI Pnone No, � �� Power $uppl� Ad re 5 � /�-� � ,�'1�02.� , � Electnc ntractor ICompany Namel Contractor s License No. Mail�nq Add�Contractor or Owner Makinp Insta�lat�onl / � / � �- Auth ized Sipnature (Co ctor Owner Makinp tnstallation) Phone Number �l � �'� �