P - 84600FRIDLEY 0931 �nivc�any ...� .... ... ....._...
Fridley, Minneso►a 55432 FAX (612) 571-1287
REQUEST FOR ELECTRICAL INSPECTION
""X" Below Work Covered by This Request
Add R� . Type ol Buildinq Avu�iancss Wired
Home ��9e
Duplex Water Heater
Apt. Building Dryer
Commercial Bldg. Furnace
Industrial Bldg. Air Conditioner
F ther Peci v
arm
t r ueci v
ite lnspect�on Fee Below
Fee Ssrvic�Entranc�Si:e
0 to 1 UO Am s
101 to 200 Amps
Above 200 Amp;
� Final'
1n013
Equ�pmenl Wirad
Temporary Service
Lighting Fixtures
Electric Heating
Silo Unloader
Bulk Milk Tank
iher (Specify)
Fee Feeders�Subtesdars N Fee Circuits
0 to 30 Am s 0 to 30 Am
31 to 100 Amps 31 to 100 Am
Above 100—Am s Above 100_Am �
Remote Control Circ. Partial/Other Fee
Special Inspection
S/�� TOTAL FEE
� ,�
Date I, th� Electrical
. InsDector, her�by
cerufy th�t ths ebov
� �'��P p� insp�ction hss b�sn
! /s . �-r— �_./ mide.
This request void �
18 months from
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T�,S «q�e5, �o,d � 1 �� 13
18 months trom
�6- �'� �a 7'�Y�
Requesj) Date f�re No. Rouqh-in InsDect�on
! �� /"�/� Neaquired? ❑ �Readv Nuw QW��I No�ifv InsPec-
� `'�� Yes No tor When Ready
Licensed Electncal Contractor 1 b���by r�qwst inapscnon ot abov
Owner sl�ctrical wwk install�d st: