P - 82971FIV�LLI V�v V Fridley, Minnesota 55432 FAX (612) 571-1287
REQUEST FOR ELECTRICAL INSPECTION
"'X'" Below Work Covered by This Request
Add pep. Type ot Building Appliances Wired
Home Range
Duplex Water Heater
Apt. Building Dryer
Commercial Bldg. Furnace
I�d�ist�ial Bldg. Ai� Conditioner
Farm Other peci v
t r yecify ther
ompute lnspection Fee Below
1���7
Equ�pment Wired
Temporary Service
Lighting fixtures
Electric Heatinq
Silo Unloader
Bulk Mllk Tank
ther lSpecifyl
01her
a � Fea SsrviceEntrsncsSiza # Fee Feeders/Subfeeders p fee Circuii
0 to t UO Am s � to 30 Am s � to 30 Am
101 to 200 Amps 31 to 100 Amps 31 to 100 A
Above 200 Am Above 700—Am s bove 100_
Transformers Remote Control Circ. artial�Oth�
Si Special Inspection
S / �`�d TOTAL FEE
in
te �, ths Elect�icsl
. Inspsetor, hersby
certify thet ths above
Final , �'��P i�apection has been
msde.
This redu�es/t vo�d'�
"�iiiip�V,�i .f ri-�'a1��.'��w����'w"�-��-«r�rt
Th�s requesl vo�d •. /� 1 O 0 5 7
18 mpnths trom /O /
l ��
Request Date fire No. Nouqh-�n Inspecuon
� /^� � Re❑qu�red? �Ready Nuw Q W�II Notify Inspec•
3 Yes � No tor When Ready
❑ icensed Electncal Contractor t heraby request inspection of above
ner slsctrical work installsd at:
Street qddress, Box or ijry�te No. _ n C�ty _
Occu tIPRINTI
�{.i( \ TT /� �
Power Suppl� _
Eiect��ca1 Co�tractor �Company Namel
��a )�3�./L
AAait�np Add��Contractor a Ownsr
�
Autf�orized Sianawrt IContrac�o� Own
�fl ��stailat�on
^9
Pnone No.
J�iZ,?Z-+l %� l �/
Contractor's License No.
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