P - 83528rI�IULt.Y Fridley, Minnesota 55432 FAX (612) 571-1287
REQUEST FOR ELECTRICAL INSPECTION
"'X'" Below Work Covered by This Request
Add pep. Type ot Buildinp Appliancea Wired
Home Range
Duplex Water Heater
Apt. Building Dryer
Commercial Bldg. Furnace
Industrial Bidg Air Conditioner
fes
Farm
t r peci Y
�ection fee Below
Servic� Entrsnc� Sizs
0 to 100 Amps
101 to 200 Amps
5igns
�iemarks
Rouph-in
Fina� �
Th�s requestyq/tl , � �
18 nqnths f��!�� j r/
�
This rdquest vo�d �
18 rtqntl�s trom
Rtequest Date
�a ��- �
Ucensed Electncal Contractor
] Owner
Fee Feeders/Subfeeders p
Oto30Ams
31 to 100 Amps
Above 100—Am s
Remote Control Circ.
^ Speciallnspection S
1���6
Equipment Wired
Temporary Service
Lighting Fixtures
Electric Heatinq
Silo Unloader
Buik Milk Tank
ther (Specify)
Other
lP.
fee Circuits
0 to 30 Am �
31 to 100 An
Above 100_
TOTAL FEE
I, th� Elecniesl
Inspsctor, h�r�by
e�rtifY tfat tlro ebov�
inapection has besn
mads.
`�5� 10096
, �a �' 9
re No. Rouph-in Inspecuon
Required? ��ieady Now ❑ W�II Notifv I�spec-
�Yes ❑No tor Wl�n Ready
1 A�rsby requ�st inspsctlon of �bov
sl�ctriesl wwk installsd at: