P - 84295Fridley, Minnesota 55432 FAX (612) 571-1287
REQUEST FOR ELECTRICAL INSPECTION
"'X" Below Work Covered by This Request
� E,r���
Add Rep. Type ot Buildi�g
Appliances Wired Equlpment Wired
Home Ran9e Temporary Service
Duplex
Water Heater Lighting Fixtures
Apt. Building Dryer Electric Heatin
Commercial Bldg. Furnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
ther Pec� v the� (Specitvl
Farm
t r peclfy
ire lnspect�on fee Below
Fse SsrvicsEntrsnceSizs
Otol00Am s
101 to 200 Amps
Above z00 Am .
Transformers
signs
� e�� . °�
-In
Fee Feeders�Subteeders p Fee
Oto30Am s
31 to 100 Amps
Above 1�—Am s �
Remote Control Circ. —
- Special Inspection S -F
is.�
%' ��2_����
Date
I final
� �
Th�s reduest vo�d
18 n�onths from
�ss�: ���� ��.� '
Th�s request vo�d •
18 months from
f s0�
Fequest Date Fire No. q
I- �3 -��
� Ucensed Electncal Contractor
1 Owner
Dnte
circui
0 to 30 Ami
31 to t UO A
Above 100_
Partial�Oth
TOTAL FEE
I, ths Electrical
Inspector, hereby
caitity that the ebove
insDection has bsen
meds.
� � � �02
ueh-in Inspect�on
qu�red7 �Ready Nuw Q W�II Noufy inspec-
]Yes ❑No tor When Ready
1 he�sby request i�spechon of above
elsctrical work inatalled at: