P - 82741I�IV VLGI Fridley, Minnesota 55432 FAX (6
REQUEST FOR ELECTRICAL INSPECTION
"X" Below Work Covered by This Request
Add Rep. Type ot Buildi�q Appliances Wired
Home Range
Duplex Water Heater
Apt. Building Dryer
Commercial Bldg. Furnace
Industriaf Bldg. Air Conditioner
Fa�m Other peci V
t r peci y t er
Compute lnspection Fee Below
� � ��
Equioment Wired
Temporary Service
Lighting Fixtures
Electric Heatinq
Silo Unloader
Bulk Milk Tank
ther lSpec�fVl
Olher
p - Fss SarviceEntrene�Si:s # Fee Feeders/Subfeeders N fee Circuita
0 to 1 UO Am s 0 to 30 Am s 0 to 30 Am
101 to 200 Amps 31 to 100 Amps 31 to 100 Am
Above 200 Am Above 100_Am s Above 100_AmPs
Transformers Remote Control Circ. artial/Other Fee
Signs Speciallnspection S
TOTAL FEE
Remarks .,,� � .
Ro ugh- i n
Da�e �, th� Elsctricsl
- . Inspsctor, hersby
certify th�t th� above
F�nal �`��P ^� i�apection has bsen
mede.
Th�s re e � v �d �
���8 ��n����������-�-�
Th�s request �o,d � 10 0 5 4
18 months from �
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JQ'Ucensed ElecVical Contractor
❑ Owne�
Street Address, Box or ute No.
�J K U(/
Occu t IPRINTI
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Fower Suppli .
Ele �cal Comractor Company Namel
S
Maillnp Address (CootFpctor or Owner
tura
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. G
r
np Instai
1 h�r�by r�qu�st i�spsction of abov�
slsatricsl work installsd at:
Pnone No. ✓
�cs�d�'�
Contractor's L�cense No.
J ����o�- /
Pho�e Number