P - 83355I�VVa_LI Fridley, Minnesota 55432 FAX (61Z) b/1-�eui
REQUEST FOR ELECTRICAL INSPECTION
"'X" Below Work Covered by This Request
Add pep. Type of Bu�ldiny Appliances Wirad
Home Range
Duplex Water Heater
Apt. Building Dryer
Commercial Bldg. Furnace
Industrial Bldg. Air Conditioner
Farm ther pec� v
t ier ueci y
ite lnspect�on Fee Below
Fss ServiceEntrsnc�Si:s
0 to t UO Am s
101 to 200 Amps
gns
in
F�nal "\ �
Th�s reQu id
,e �b�,�5��622 .
ThiS request void �
18 months trom �
re
� �censed Electncal CoMractor
Owner
Street Address, Box oule No.
/
Occupam 1 TI
�.. _.
Power $uDD��er .
Electr�cal Co ractor ICompan Namel
Maillnp Addres ontractor a Ownsr
Autl+or�zed S�onetun IComracto rM
Fee Feeders�Subfeedsrs �
Oto30Ams
31 to 100 Amps
Above 100_Am S
Remote Control Circ.
Speciallnspectio� S
Equ�pment Wired
Temporary Service
lighting Fixtures
Electric Heatinq
Si lo Unloader
Bulk Mllk Tank
�her lSpeufvl
IP.
fee Circ
0 to 30 A
31 to 100
TOTAL FEE
1, th� Electrie�l
Inspsctor, h�r�by
e�nify thst th� ebovs
'rrispsction hss been
mede.
�-�' `� '� 10 0 9 2
�ph-in InsDecUOn
�u�red? �Ready Nuw Q W��� Not�fv Inspec-
]Yes ❑ No ror When Readv
I h�r�by ��qwst inapection of abov�
slsc�ricsl wwk installed at:
np Inetailation)
;IAp I�sullatic
%
Pnone Na.
ractor"s License
ioer