P - 82620L.l 1 Y VC 6431 University AvenuerNortheast �) ���-�ae5
FRiDLEY Fridley, Minnesota 55432 FAX (612) 571•1287
REQUEST FOR ELECTRICAL INSPECTION
"'X" Below Work Cove�ed by This Request
Add ReD• Type ot Bullding Appliances Wired
Home Range
Duplex Water Heater
Apt. Bui�ding Dryer
Commercial Bldg. Furnace
Industrial Bldg. Air Conditioner
Farm Other pec� v
� � pe�i(y iher
Compute /nspect�on Fee Below
p �F SarviceEnt�anceSize # Fea Feeders�Subfeede�s a
ol00Am s �to30Am s _
1 to 200 Amps 31 to 100 Amps
Above 200 Amps Above ��-Am s
Transformers Remote Controt Circ.
5 Speciallnspection S
Remarks - � � -. ��0�� '
C
i Rouah-m
Final
�i J 14 8
Equipment Wired
Temporary Service
Lighting Fixtures
Electnc Heatmg
S�lo Unloader
Bulk Milk Tank
Other �SDeC�fyl
Other
Fee Circuits
0 to 30 Amps
31 to 100 Am
.��� Ahove 100_.AmP`-
Part�al�Other Fee
���o� TOTAL FEE
�1e I, the Eleetncnl
Inspector, hereby
certilv that the nbove
'�«' inspattion has bean
Z /l__/X' mede.
Th�s reduest vo�id
]H n�nnths.from . .������,�����_
�����������.a���+`���.. ��
�`� - I
Th�s request vo�d � ��� _� ��; � � �
18 months trom �
L
Request ate Fire No. Rough•�n Inspection
Required� �Readv Nuw Q W�il Notif� Ingpec-
�"'` �� �� ❑ �es � No �or When Ready
Licensed Electncal Conu�ctor I heroby request �nsuect�on of above
, ❑ Oovner electrical work installed at: