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P - 83914FRlDLEY i ey, Minnesota 5u FAX ) 71-128, ��`�� REQUEST FOR EIECTRlCAL INSPECTION �'`� '"X" Below Wo�k Covered by This Request Add Rep. Type of Building Appliances Wired Equlpment Wired Home Range Temporary Service Duplex Water Heater Lighting Fixtures Apt. Building Dryer Electric Heatm Commercial Bldg. Furnace Silo Unloader Industrial Bidg. Air Conditioner Bulk Milk Tank Farm O�her peu v �her (Spec�f�1 1 r Uecify ther Other ' �mpute /nspection Fee Below Fee SsrviceEntrancsSizs 0 to 100 Am s 101 to 200 Amps Above 200 Ampe Transformers Signs emarks ` / � —�'4,Z�L�I ��- ough-in �Final � Th�s request void 18 nanths from 25�f�2 Th�s request void • 18 months from Request Date //- �- 9� �Licensed Electncal ConV�ctor � Owner Street Address, Box or Route No. ��,� � � .�� Occupa�t IPRINTI Power $upqlier Electr�ca+ Contractor ICompany f � %�-S ► �i x1,2. MaiGnp Address 1 ontractor or C �301�/ �rq,�" l.r AuMonzed Sipnature (Contractor � ie Fee Feeders�Subfeeders � Fee Circuits Oto30Am s �to30Am � 31 to 100 Amps 31 to 100 Arr Above 100_Am s -----� Above 100_ Remote Control Circ. Partial!Other Speciai Inspect�on � S�% /� G� TOTAL FEE / 2 n.�te I, ths Electrical . Inspeetor, hereby certity that the ebove �P inspection has been �7 /n made. �� r��3 ��/ � /.��Q �gh-in Inspecnon iuned? �Ready Nuw Q W�II NoUfy Inspec• ]Yes ❑No tor When Ready t hersby requesi inspect�on of above electrical work inatalled at: City �"/�.� � �-�= Pnone No. �./ �/ �l Ci�/�l Ui" Contractor's License No. C'i'�fC'_ kinQ Instailation) np instaliBt�oni q rhone ivumber