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P - 80643�'� �� �� 6431 University Avenue Northeast (6iij' 777-7885 FRIDLEY Fridley, Minnesota 55432 FAX (612) 571-1287 REQUEST FOR ELECTRICAL INSPECTION "`X'" Be/ow Work Cove�ed by This Request Add Rsp. Type of Bullding ApDllances Wired Home Range Duptex Wate� Heater Apt. Building Dryer Cortxnercial Bldg. Furnace Industrial Bldg. Air Conditioner Fdrm � Other pec� v >ute lnspect�on fee Below fea Sarvics Entrsncs S�:e � to 1 UO Am s 101 to 200 Amps Above 200 Amp; Transformers Signs rks � i-in Fee FeederslSubfeeders p 0 to 30 Am s 31 to 100 Amps Above 100 _. Am s Remote Control Circ. Special Inspection S i,�? � ( Equlpment Wired Temporary Service Ughting Fixtures Electr�c Heat�ng Si lo Unloader Bulk Milk Tank Iher l$PECIfV) Fee Circuits 0 co 30 Am � 31 to 100 Arr Above 100� Partia l!Other i /y TOTAL FEE te I, ths Electrlqal . . Inapsctor, h�reby corUfy that ths nbovs ' ;nal Date ��spschon haa bssn � mada. Th�s reQUes 18 nantAs f�om .�����..L��..������ - r �a �- �� - �s�ew'��c > N � � This request vo�d ' /%/�1 101 17 � 18 months from 7� ✓ Reique ate fire No. Re4uhedn�InsDecnon �Readv Now Q W�II NoUfv InSDec- ��.- g 9 ❑ �es Q No ror When ReadY [] L�censed Electnca� Cont��ctor 1 h�r�by r�pwat inspect�on ot sbove slectrical work ina�allsd at: