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P - 83266
CIV�LLI Fridley, Minnesota 55432 FAX (6 REQUEST FOR ELECTRICAL INSPECTION "X'" Below Work Covered by This Request Add pep. Type ot Buf Idin9 Appl isnces W ired Home Range Duplex Water Heater Apt. Building Dryer Commercial Bldg. Furnace Industr�al Bldg. Air Conditioner Farm o�ner pe�� v t r ueciry t er Compute lnspection fee Below � � � � � Equipmsnt Wired Temporary $ervice Lighting Fixtures Electric Heatinq Silo Unloader Bulk Milk Tank ther (Specifyl Othe� a � Fse ServiesEntrsnc�Sizs k Fes feeders/Subfeeders p fee OtolUOAm Oto30Ams 101 tq 200 Amps 31 to 100 Amps Above 200 Am Above 100_Am s ormers Remote Control Circ. $�gns ` pecial Inspection S/� Remarks � , _ ,. n Flnal � to 30 Am� 31 to 100 A Ahove 100_ TOTQt FEE I, th� Electrical . Inspeetor, h�r�by e�rtif� th�t th� ebov� �p „ ina�etion hss be�n 7MS request void •J (; !�-�� - 18 nqnths hom �� � V T�,S .�q�eg, �o,a � �� 4d � 10 0 8 2 18 months from � / 1 / LjG� XJ Request Dat fire No. Rouph-in Inspecuon Requuetl? �Ready Nuw [] W�1I Noufv Inspec- ' S�9 o Yes ❑ No ro. When Reaov ❑ licensed Elect��cai Contrector � h�r�br ��awst inspsction of abov� �Ow�e� el�etricsl wwk inatalled at: Occupan RINTI � Power $uppller �.� Electncal Cont or ICompeny c'z�v�� Malllnp Addr� (Con�p� \ l V AuMo�ized Sipnatw� IContract op Inatailallon 7h:`.�_ on Pno��e No. J G � �i"U � Cantracto��s L�cense No.