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
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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.
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18 nanths�op h t` O
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This reduest void �� / /// /� �'�/ � Q�� 6
18 month5 trom � / ..,�'� � �
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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
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