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P - 80722�'' '' � 6431 UnTversity Avenue Noriheast �/�5 FRiDLEY Fridley, Minnesota 55432 FAX (612) 571-1287 REQUEST FOR ELECT�iICAL INSPECTION ""X�" Below Work Covered by This Request Add Rev� ypa ot Buliding Apo��ances Wired Home ��9e Duplex Water Heater Apt. Building Dryer Comnercial Bldg. Furnace Industrial Bidg. Air Conditioner Fa�m . Other Der.� v t r peci(y t er Compute lnspection Fee Below � ..� 5 / � '', ��+ Equipment Wired Tem�orary Service Lighting Fixtures Electnc Heatinq Si lo Unloader Bulk Milk Tank ther ISoec�fyl k fse ServicaEntrancsSiie k Fee Feeders�Subfeeders p Fee OtolUOAm 0to30Am s 101 to 200 Amps 31 to 100 Amps Above 200 Amps Above 100—Am s Transf ers Remote Control Circ. � Signs Special Inspection S ��` r �� rate J:+le circuics 0 to 30 Amps 31 to 100 Amps Above 100_Amp; Partial!Other Fee TOTAI FEE 1, the Electricel Inapector, hareby certify thst the ebove Final - � • inspect�on hss bssn . Z.�, meda. This request v �' 18 nanths fi � :'� . � /S�rO � Y - - - Th�s ,�a�e5► �o,d � � �, 3� 9r7 � 101 14 18 months from � R�y�t.Date Fire No. Houph-in Ins�ecNon Reauved? �Readv Now O W�11 NoUfy InSpeC- Q❑ Ves � No tor When Ready ❑ icensed Electncal Contractor I haraby rsquast inspect�on ol abow � ' Owne� slectrical work inatalled at: Street Address, Box or Route No. % / �o� Occupan IPRINTI �� Power uPDlfer ♦ . J �S � Electncal rector I� nv Name) � �/ Malllnp Address ntractor w Owne� Author�zed SiQnature IComractor Own `�V �ny Instailat�on) aiy/�a ��stallation Pnone No. �� I Contracto�'s License No. umber