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P - 82555FRiDLEY vYO �nrveraiiy Nvenue rvunneas[ �� iii-ivao ( Fridley, Minnesota 55432 FAX (612) 571-1287 1 J 14 5 REQUEST FOR ELECTRICAL INSPECTION � �'S _� � � ""X"' Below Work Covered by This Request Add Rsp. Type of Building Appllances Wirad +� Fse Remarks Rough-in Final Dupl ex Apt. Building Commercial Bldg. Industrial Bldg. Farm t � uecify �ection Fee Below Servics Entrancs Size 0 to 100 Amps 107 to 200 Amps Above 200 Amos Water Heater Dryer Furnace Air Conditioner O�her pec� v Other Fae Transformers � Signs /�C.�N�� R�r,�,o�c.. Faeders�Subfeedars 0 to 30 Amps 31 to 100 Amps Above 100_AmF Remote Control Circ Speciallnspection Equ�pment Wirgd Temporary Service Lighting Fixtures Electric Heat�nq Silo Unloader Bulk Milk T�nk iher iSGe�.�ifv) Other Fee Circuits 0 to 30 Am 31 to 100 Am S Ahove 100_Amp Part�al!Other Fee �3b TOTAL FEE ❑te I, ths Elactrlcsl � Z�_�d Inspector, hereby certify that the ebove specLOn has been mede. Th�s �eduest vo�id � . 78 nanths from �� r�� -.�� r�i�—��+��cr.. - Th�s request vo�d �� ,yj �� `� 'j �,� ., �; j r � 18 months from 'TF .-�'- i "�bi `/t �J r.quest Uate � a�� 'DU J..+�censed Electncal ConVactor ❑ Owner ��e No. Rouph-in InsDec[�on Required� �eady Nuw ��II Nolify InsPec- �es � No ror When Ready � hereby request inspechon of above elect�ical work installed at: Street Add�ess, Box or Route No. C�tv �P8a0 ` 7`'��- �7; iv�; ,�- Occupant IPRINT) Pnone No. �t�•cJ � // �% lo �'�' Power SupD��er Address Electncal Contractor ICompany Namel Contractor's License No. /%�,e'?t�E� � EG%�tf�C .��/�- $ �.4 O Z. 2 Mail�np Address lComracto� or Owner Makinp Instailanon) o��` - /�'�.� .4�.. •v� � l�✓ ` , .�'C�� Auth r $iy tu�b ractor Owne� Mak�np In5ta11aUOn) P�e Numb� �� y