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P - 82037•'' �� 6431 University Avenue Northeast (69f� 777•7885 FRiDLEY Fridley, Minnesota 55432 FAX (612) 571-1287 REQUEST FaR ELECTRICAL INSPECTION "'X'" Below Work Covered by This Request Add ReD� Type ol 8u�lding ApDliances W�rad Home ��9e Duplex Water Heater Apt. Bui Iding Dryer Commercial Bldg. Furnace Industrial Bldg. Air Conditioner Fafm - O(her pec� v t r uecily t er Compute lnspection Fee Below p Fse Sarvics Entrance Fee Feeders�Subteeders p � to 1 UO Am s •. 0 to 30 Am s 101 to 200 Amps 31 to 100 Amps Above 200 Am s Above 1�—Am s Transformers Remote Control Ciic. Signs Speciallnspection S tks ��R,�, s�o��, Roupn-in Fina� _.�..,�..o -- - ThiS reques� vo�d 18 months trom rReauest Da�e I � � _ � �,; : J Equ�pment Wired Temporary Service Lighting Fixtures Electnc Heatinq Silo Unloader Bulk Milk Tank O�her ISpeufvl fee Circui ` 0 to 30 Am 31 to 100 l �"'� Above 100. �� Partia{!Oth �� TOTAL FEE '""" I, the Elecsrical . . Inspector, hersby certity thst tha ahove �'��P inspsct�on has bsen '�'•�' �j meds. �, _��___� _._.��__--�__.—��—..�..___ �%� ,ov � 10215 ��� fire No. Rouqh•�n InSpecNon -, Aequ�red? �Ready Now Q W��I Notify Inspec- r.�V�{ � ves ❑ No �or When Ready � Licensed Elec[rical Contractor L` 1 hereby rsquest inspect�on of sbove nv ,. _ � �vwner a�scmcs� wo�w �ns�aiieo ar. . Street Address, Box or Rout .� C�ty �'f3J- _ �-� NE ,� ���� Occupent IPRyNTI �none No. L-� laye L ^lESO � Power $upDl� Add s -� � cs o,�� i���� Electr�cal Contractor ICompany Name) Contractor's L�cense No. �Fl nG2 � Maillnp Address (Contractor q Owner Mak�np Instailat�on) '7 Vr "V Author�zed S�pne[ure IContractor Owner Maklnp Installat�onl Phone Number 7� 3 � 37l- 739b