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
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This request vo�d ' /%/�1 101 17 �
18 months from 7� ✓
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[] L�censed Electnca� Cont��ctor 1 h�r�by r�pwat inspect�on ot sbove
slectrical work ina�allsd at: