P - 82006C� '" O" 6431 University Avenue Northeast f6�2) 777•7885 .1�� j �)
FRIDLE.Y Fridley, Minnesota 55432 FAX (612) 571-1287 I Li I If /
REQUEST FOR ELECTRICAL iNSPECTION
""X'" Below Work Covered by This Request
Add Rep TYDe ot 8uildfng ARD��ances Wi�ed Equ�pment Wired
Home Ra�ge Tem�orary Service
Ouplex Water Heater Lighting Fixtures
Apt. 8uilding Dryer Electnc Heatin
Commercial Bidg. Fumace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm
O�her pec� v ther iSoec�ty�
t r ueci y t er Other
Compute lnspecuon Fee Below
tt fea SsrvicsEntraneeSi:e k Fee Feeders�Subfeeders M fee Gircuits
0 to 1 UO Am s 0 to 30 Am s � to 30 Am
�p} p 200 Amps 31 to 100 Amps 31 to 100 Am
ve 200 Amps Above 100,.Am s Above 100_...Am s
Tran formers Remote Control Circ. PartiaVOther Fee
Si s Special I�spection 5�
Remarks `� �� c TOTAL FEE
Rough-i�
Dace �, �, ths Elsctrieal
. % Inspector, hersby
� certifv thet ihs abovs
Final �^�P-�"� i�apection hes bsan
7 '1.Q 'Cl� mads.
.r� h � r u t vo�i d �..-��...._ ����_�.� �. � �..__. _._ « ---- �""— .
Th�s request vo�d ��� �
18 months from � ,e.� �a�� 1017 9
,�m� s�n�
Resquest Date f�re No. pQ�uphe�n�lnsoecuo� �qeadv Now �] W��I Notify Ingpec-
��� � O, ❑ ves � No tor WAen qeady
❑ �censed E�ectncai Co�tr�tor
Owne� �� (�
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Street Address, 8oz nr �te No.f
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Electncal Con ctor ICompanv Nan+e1
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Mail�np Addreye�IC� tor w Ownsr
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AuMorized S�aneture iCoMractor Own
1 hareby re4ueat i�spect�on of sbove
slsctrical work inatalled at:
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Address
Aakinp Instailation)
r Mak�no Installatio�
Pno�ie No.
ontracto�'s License No.
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