P - 78609FRIDLEY v ° ' " °, ° °� �", ,,,-, °
Fridley, Minnesota 55432 FAX (612) 571-1287
REQUEST FOR ELECTRICAL INSPECTION
""X'" Below Work Covered by This Request
Add Rsp. Type ol Bwlding Appliances Wired
Home Range
Duplex Water Heater
Apt. Building Dryer
Commercial Btdg. Furnace
Industrial Bldg. Air Conditioner
FdffTl - � Iher peu v
t r UeCi y �hgr
Compute lnspection Fee Below
1�1f1U
Equ�pment Wired
Temporary Service
Light�ng Fixtures
Electric Heat�ng
Silo Unloader
Bulk Milk Tank
Iher ISPCCiIyI
M Fee SsrvicsEntrenc�Size p Fee Feaders�Subleede�s p Fee Circuits
OtolUOAm s �to30Am s �to30Am
101 to 200 Amps 31 to 100 Amps 31 to 100 Am
Above 200 Am s Above 100-Am s Above 100_Amp�
Transformers Remote Control Circ. Partial!Other Fee
Si Specialtnspect�on 5
TOTAL FE
n
I Final /"'
l
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This reduest vo��d
18 nanths from
� Th�s request vo�d
18 months from
te
❑ Licensed Electncai Co�tractor
Owner
Street A�r 55.��Bax q�ib�
1 .
Occu a t IPAINT)
Powar SuDDl�er _ � .
�� E
���� I, the Elecnlcal
. Inspector, hersby
csrtlfy thst tha ebovs
�'��P insp�ction hss besn
z �o—� �a..
� 5�7 1 � �� �
ire No. Rouqh-�n InsDect�on
Required? �Ready Nuw � W�11 Noufy Inspec-
❑ �es ❑ No tor When Ready
1 hersby request inspectio� of above
slsctrical work inatalled at:
n � C i t V �+�
5
Elect��a o� (� ny Namel
Ma111np Add� (Contractor or Owner MakinQ Instailationl
�i��n�
AuMo�aed S�pnature (Contrector Owner Mak�ny Installatio�
Pnone No.
Contracto�"s License No.
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