P - 84646FRIDLEY �"° V ° ' ' � ° ` ,. ... .
Fridley, Minnesota 55432 FAX (612) 571-1287
REUUEST FOR ELECTRICAL INSPECTION
"'X' " Below Work Covered by This Request
Add ReD• Ype ot Buildin9 APD��ancss Wired
Home Flange
Duplex Water Heater
Apt. Building Dryer
Commercial Bldg. Furnace
Industrial Bldg. Air Conditioner
F ther pec� v
arm
t r UeC�fy
ute lnspect�on Fee Below
fee S�rviesEntrane�Sizs
0 to 1 UO Am s
101 to 200 Amos
in
Final
��
Fee Feeders�Subteedars A
Oto30Am s
31 to 100 Amps
Above 100_Am s
Remote Control Circ.
Specia� Inspection S
10015
Equ�pms�t Wirsd
Temporary $ervice
Lighting Fixtures
Electric Heat�ng
Si lo Unloader
Bulk Mllk Tank
ther ISpec�fvl
Fea Circuits
0 to 30 Am
31 to 100 A
Above 100_'
Partial�Other F
�� TOTAL FEE
-- 1, the Electrical
. InSpsctOr, h�r�by
wrtify thet ths ebovs
�P insp�ction hss besn
, �y� mrda.
Th�s reduest vo�d ' �
18 nqnths f�om
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Th,S ,�a�eg� �a,d 1 Q� 15
18 months from �
l.S.o� �31 �1
Repuest D ce fi�e o. Rouph-�n InsDection
ReQuired? �Ready Now Q W�i1 NoUfy Inspec-
' �O ` ❑Yes ❑No [or When Ready
� Licensed Electncal Contractor 1 h�r�by rsqwst inspschon ot sbov
❑ �w^e� alectrical work install�d at: