P - 80650�< << V� 6431 University Avenue Northeast E6�2) 777-7865
FRIDLEY Fridley, Minnesota 55432 FAX (612) 571-1287
RE�UEST FOR ELECTRICAL INSPECTION
"'X'" Below Work Covered by This Request
Add ReD� TVOe o1 Building Appliances Wirad
Home ��9e
Duplex Water Heater
Apt. Building Dryer
Commercial Bldg. Furnace
Industrial Bldg. Air Conditioner
Farm Other Deci V
t r pecify ther
Compute lnspect�on Fee Below
# Fea SarvicsEntrsnceSiza k Fee Feaders�Subfeeders p
Otol00Am s �to30Am s
101 to 200 Amps 31 to 700 Amps
! bove 200 Amps Above 1�-Am s
ansformers Remote Control Circ.
Signs Speciallnspect�on
Remarks i1��`I ���
Y
Ro uah- i n � �
Final
� .p � z �
�.: i I
Equ�pment Wired
Temporary Service
Lighting Fixtures
Electr�c Heating
Silo Unloader
Bulk Milk Tank
�her (SD@��IV)
fee clrou;ta
0 to 30 Am
31 to 100 Amps
Above 100..._AmP=
:�,,..� Partial!Other Fee
�� TOTAI FE�
te I, th� Electncal
Inapector, hersby
csrtity thst ths abow
�p Q�� inspsction hss bssn
� �A�77` meds.
This reQuest vo•�d
18 nanths f�om
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�5 ,
T�,S ,�q�eg, �a,d �/OQ 101 16
18 months trom
Request ate F�re No. qequued?��sDecnon �qeadv Nuw Q W�11 NoUty I�spec-
���� �� ❑ 1'es [] No tor When Ready
icensed Electncal ConVactor I beraby rsquest inspecuon ot above
Owner slectrical work inatalled at: