P - 82623F�'� �� v� 6431 University Avenue Northeast
RlDLEY Fridley, Minnesota 55432 FAX (61� 571-1287
REQUEST FOR ELECTRICAL INSPECTION
""X" Below Work Covered by This Request
N Add Rep. Type of Building Appliances Wired
Home Range
Duplex Water Heater
Apt. Building Dryer '
Commercial Bldg. Furnace
Industrial Bldg. Air Conditioner
Farm Other peci y
t r uecity Other
'ompute lnspect�on Fee BeJow
a F
I � � 4 (�
EQu�pment Wired
Temporary Service
lighting Fixtures
Electnc Neat�nq
Silo Unloader
Bulk Milk Tank
Other iSOe�;�fvl
(�1her
ee Serv�ceEntranceS�ze p Fee Feeders�Subfeeders 1J Fee Circuits
Otol00qm s Oto30Am s 0 to30Am �
Q♦ � 191 to 200 Artios 31 to 100 A
l �
in
n�Ps 31 to 100 Am
Above 100_Amps Above 100_
Remote Control Circ. Partial�Other
5pecial Inspecti�n S —
�/� c �Q�Q� TOTAL FEE
( I ICrJG�
��c�
� F�nal
� �/$Lr
This reduest vo�id —
I� 1$����h ���°��.�����^ ..��.��...����....�� _—_
_ = � _
This request vo�d �,L�%�
18 mpnths from � C�1
��,l�� 1 J 14 y
R�quest D
F N Reqehed �nspecnon
��� ��Q �Ready Now Q W�il N�tify Inspec-
❑ L�censed Electncal Coniractor �Yes ❑ry� tor When Ready
Owner � hersby request �nspection ot above
electrical work installed at:
Street 9tldress, Box or Rout� No. _
C�tv_�
I, ths Electncei
Inspector, hereby
cerfify that the abova
�d�� inspectlon has been
� �2._ mads.
Occup IPRINT) --�
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Power $uppl��/�
Electrical Cont ICompa
biailinp Address Cr,.,..�,.�.
�re o.
np ingtallation
Pnone No.
�' ' / // V�J/(
Contractor's License No.
uMoriZ9d S�fl�ture (Contractor Owner Makin9 Installation)
Ph�� � e...