P - 84026I��� Fridley, Minnesota 55432 FAX (6
REQUEST FOR ELECTRICAL INSPECTION
"X" Below Work Covered by This Request
1��42
Add Rep. Type o( Buildinq ApO��ances Wired Equlpme�t Wired
Home Ran9e Temporary Service
Duplex Water Heater Lighting Fixtures
Apt. Building Dryer EleCtric Heatin
Commercial Bldg. Furnace Silo Unloader
Industrial Bldg. Air Co�ditioner Bulk Mllk Tank
Fdfrtt - Other pec� V iher ISpecifyl
t r Vecify the Other
Compute lnspect�on Fee Below
p � Fee SsrviceEntranuSize # fee Feeders/Subteeders b Fee Circuits
Otol00Am s Oto30Am s Oto30Am
101 to 200 Amps 31 to 100 Amps 31 to 100 Am
Above 200 Amps Above 1�-Am s Above 100_Amp:
Transformers Remote Control Circ. - Partial!Other Fee
S��s ^ Special Inspection S/���� TOTAL FEE
qouph-In
F�nal �
Th�s reduest void
18 nanths from 2 5�
�' � �.�
1 / 'i� !J`��r%�
Date �, the Eleetrieal
. Inspector, he�eby
certify that the above
�? D��P i�sPaction hes been
// e _..../�y c7� mede.
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Th�s request vo�d �� �� ��� �.s Y.�
18 mon[hs from
Request Date Fire No. RouQh-�n Inspecclon
�yJ � Re4u�red? �Readv Nuw ❑ W�11 Noufv InsDec-
%� —�; ❑ Ves ❑ No tor When qeady
Ucensed Elec[ncal Contractor I hereby request inspechon ot above
� Owner electrical work ina�alled at:
B t No C'tV �'
reet Address,� o■ or�tou e� .
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Power upplieAAr .
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Ele t�ical Contractar ICompany Namel
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Mall�ny Address IContractor o� Owner
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AuMonzed Sipnacure (Contrector Own
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Ad r ss
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np Instailation)
F�A- /n��� % G�l
�kinp Installation)
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Pno��e No.
ontractor's License No.
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N umber
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