P - 83763Fridley, Minnesota 55432 FAX (612) 571-1287 � F•., <y ��
REQUEST FOR ELECTRICAL INSPECTION � �
""X'" Below Work Covered by This Request
Add Rep. Type o( Buildin9 Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Lighting Fixtures
Apt. Building Dryer Electric Heatin
Commercial Bldg. Furnace Silo Unloader
Industrial Bldg. Air Co�ditioner Bulk Milk Tank
FdffTl - Other peci y the. (Specify)
t r UecifV t er Other �.
Compute lnspection fee Below
� Fse SsrviceEntrsnceSize p Fee Feeders�Subfeeders ll Fee Circuits
0 to lU0 Am s 0 to 30 Am s 0 to 30 Am
101 to 200 Amps 31 to 100 Amps 31 to 100 Am
Above 200 Amps Above 100_Am s Above 100_Amps
Transformers Remote Control Circ. Partial�Other Fee
Signs % Special Inspection S j (- L?
Re � � � + �.J(.,I �7I i /�1 .�' TOTAL FEE
" �2 'yl-�-,�-�
Rough-in Date
I, ths Elect�ical
Inspector, hersby
F�nal '7 csrtify thst ths ebove
�`��P inspsction hss besn
� ..
� --�'�,.� — - ��� � made.
This reQuest void .
18 n�onths from
Th�s request void • / /'�j��� �(.,[y�-� ��j / . � 1,�+ ,,,y � 3
18 months from / ✓ �� '� � �
�que D te Fire No. Rouph-in Inspection
r �� (p �`7y /�9� RQMes' ❑No ❑Ready Now �W�II NoUty tnspec-
tor When Ready
L�censed Electrical Contractor 1 heroby rsqusst inspectlon of above
Owner electrical work inatallad at:
reet Address. Box or Routs, No. C ity,,,,_,
OccuDent IPRINTI
Power $up lier .
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EI t ic 1 Co�tractor ICompany
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Pnone No.
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Contractor's License No.
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