P - 83206['IVVLL Fridley, Minnesota 55432 Fdx (s
REQUEST FOR ELECTRICAL INSPECTION
"'X'" Below Work Covered by This Request
Add Rep. Type ol Building Appliances Wired
Home Range
Duplex Water Neater
Apt. Building Dryer
Commercial Bldg. Furnace
Indi�stridl Bldg. Air Conditioner
c..__ . ther pec� V
Compute �nspecUon fee tielow
u fse Sarvic�Entranc�Sizs
0 to t UO Am s
101 to 200 Amps
Above 200 Am .
Transformers
Si gns
Remarks
Rouph-in
final
This re��o�
18 mont
This request vo�d •
18 months from
Fee Feaders/Subfeedera b
Oto30Ams
31 to 100 Amps
Above 1 �0 � Am s
Remote Control Circ.
Special Inspection S
� ����5
Equipme�t Wired
Temporary Service
tigfiting Fixtures
Etectric Heatinq
Silo Unloader
Buik Miik Tank
ther ISpec�fyl
Other
Date
D�te
c������
0 to .
31 to
TOTAL FEE
1, th� Elsctricai
inspsctor, h�r�by
c�rtify th�t th� ebovs
.'rnsp�ction hes beln
mada.
����� 10075
1�1� l
Request e F�re No. Rouph-�n Inspect�on
Requ�red? �Ready Nuw Q W��I NoUfy Inspec-
� " ❑Yes ❑No � tor wne� ReadY
Licensed Electncal Cont�ACtor 1 h�r�by rsqwst inapschon of abov�
Owner sl�ctrical work instslled st: