P - 84705flllULt.Y � F��die'y, Minnesota 55432 FAX (612) 571-1287 ,� ��,� 8
REQUEST FOR ELECTRICAL INSPECTION
'"X'" Below Work Covered by This Request
Add Rep• pa o1 Bu�ldinq Applia�css Wired Equlpment Wired
, Home Range Temporary Service
Ouplex Water Fieater Lightin Fixtures
Apt. Building Dryer Electric Heatin
Commercial Bldg. Furnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk M�Ik Tank
F3rm � Other pec� v ther (Soecityl
t r peCl Y ther 01her
Compute lnspection Fee Below
J1 Fse Servic�Entrsnc�Si:s M Fes Feeders�Subfeeders p Fea Circuita
�tolUOAm Oto30Ams Oto30Am
101 to 200 Amps 31 to 100 Amps 31 to 100 Am
Above 200 Am Above 100_Am s bove 100_Amps
Transformers Remote Control Circ. � Partial�Other Fee
Signs Special Inspection S �. � TOTAL FEE
Remarks � I���I +" ...,1 1 J�J�1
Rouph-in Date I, th� Electrical
. Inspector, hersby
cartily that ths ebove
final �^�P � inspection hss bsan
�f% —1 m�de.
This reQUes vo�d
18 montMs f °' (�
�ti���
�_�_ ��__ ;� -----�
1��18
��s� �3 �
Fi�e No. qequhed�lnspecc�on �peadv Now QW�II NoUfv Inspec-
/ _ E tor When Ready
//„ ❑Ves ❑No
Yr
d Electncal Contraclo� I h�rsby �equest insPecnon ol sbove
slsctrical work installed at:
i Address, Box or Rout . C��y
-., S � /�,��Q
Occu IPRINT) � � Pno��e No.
r
l� i �S �
Power SuDV�� . Addr s '
�� � � ��� � . � .
J- �
Elecuical ntractor ICompanv Namel
Contractor's License No.
i/ S
(� �� �` ��
Mailinp Addr�tractor or Owner Meklnp Instailatwn)
` � Phone Number
AuMorized Sip�stun (CoMractor Owner MakinQ Instaliation)