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P - 83952� Fridley, Minnesota 55432 FAX (612) 571-1287 REQUEST FOR ELECTRICAL INSPECTION ""X"' Below Work Covered by This Request Add Rep. Type ot Building Appliances Wired Home Range Duplex Water Heater Apt. Building Dryer Commercial Bldg. Furnace Industrfal Bldg. Air Conditioner Fafm Other peu v 1 r ueclfy ther Compute lnspection Fee Below � � Equipment Wired Temporary Service Lighting Fixtures Electric Heating Si lo Unloader Buik Milk Tank ther ISpecifvl Other a Fse SarvicsEntrenceSize # Fee Feeders�Subfeeders � Fee Circuit 0 to 1 UO Am s 0 to 30 Am s 101 to 200 Amps 31 to 100 Amps Above 200 Amps Above 100_Am s Transformers Remo2e Control Circ. — Signs Speciai Inspection Remarks S /�- 0 to 30 AmC 31 to 100 A TOTAL FEE Rough-in Date �, ths Electrical . �nsDector, hereby cerUfy that the nbove Fina� — Dnte i�sDection has been � ��- ` - made. �ov..00� ww 18 nanths�op h t` O eJ lJ j - _ � :__.= a -- - - _ � _ _, _:�� _ �..�-p-�.«o..-� �.-.,..,.-,«.�.�..t �.. � �.. • � ��..-� . This reduest void �� / /// /� �'�/ � Q�� 6 18 month5 trom � / ..,�'� � � ll/ l.� � Req st Oate F�re No. Rouph-�n Inspecnon Required? �Ready Now � W�II NoUfy inspec- / L ! ❑ Ves � No tor When Ready ❑ L�censed EIecV�cal Contractor 1 hersby roQUest inspechon ot above Owner electrical work inatalled at: Street Address, Box or oute No. Citv �7��� �2if-���r� _�;n�=f� ��� ��41�Q� Occuvant IPRINTI .�,.� / 1C � Power Supplier _ �� Electncal C ntractor IC,�mpany �LL_1 b� �� %� Ma�l�np Addres�ontractor pr 1 �J Au�f+onz Sipnature (Coqt{act Namel Instailationl np Installation) � ��o Pnone No. Contractor"s License No. umber r.� - ��� �