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P - 80628FRIDLEY 643] University�venue Ncriheast (trrr) ii'— '• Fridley, Minnesota 55432 FAX j612) 571-1287 �' '� "� REQUEST FUR ELECTRICAL INSPECTION ""X'" BeJow Work Covered by This Request Add Nep. Type o1 Buiiding ADOliances Wired Home Range Duplex Water Heater Apt. Building Dryer Commercial Bldg. Fumace Industrial Bldg. Air Conditioner Farm O�her Qeu v t r veciFy ther Compute lnspectron fee Below Jf Fsa SsrvicsEntranesSi:e k Fee Feeders�Subfeede�s b 0 to 1 UO Am 0 to 30 Am s 101 to 200 Amps 31 to 100 Amps Above 200 Am s Above 100.T Am S Transfprmers Remote Control Circ. Signs Speciallnspection S �k5 �-in � Equipment Wired Temporary Service Lighting Fixiures Electric Heatinq Silo Unlpader Bulk Milk Tank Other ISPecifvl Other Fee Circuits �� _ � 0 to 30 Amos 31 to lU0 Amps �Above 100_Amp; Partial!Other Fee TOTAL FEE I, ths Electrical Innpectot, hefsby qartifY �hat the nbova F�^a� ^�_�� inspaction hsa bssn � � � � ��� made. � �r.�– Th�s reduest vo•id � � 18 mon�S,j�p� (� � . ���.��� � '..Y �..L�.�.�slsi4.�ifii��r����tir��..-��c:.�p��raFr:.�.�.��. T�,S ,�q�e5� �o,d /�- � 0 101 18 18 mpnths from ���� Request Date f�re No. Rouph•�n InsOection `� Aequired? �Read� Nuw Q W�i1 Nout� InsOec- ���o' �� ❑ Yes [] No cor Wfien ReadY ❑ Licensed Electr�cal Contractor � � h�rpby requast i�spechon of sbove �Owner electrical work irtttal4ed at: Street Add�ess. Boa ot Roy{e No. _ City �,�: ( Occuoanl I%IINT) i Electncal Co t� or IC -t. Ma�l�np Address •�o rt AuMon2ed S�pnaturo IC 1 cn Vwner Mek�np �nstailat�o� ctor� k�np Installat Pnone No �Z� �l (�JSlO Contrecto��s L�cense No.