P - 84293ao
�� Fridley, Minnesota 55432 FAX (612) 571-1287
REQUEST FOR ELECTRICAL INSPECTION
""X'" Below Work Covered by This Request
Add Rep. e ot Building Appliances Wired
Home Range
Duplex Water Heater
Apt. Building Dryer
Commercial Bldg. Fur�ace
Industrial Bldg. Air Conditioner
Farm � Olher peu v
t r pec�fy
ite Inspection Fee Be/ow
Fse SsrviceEntranceSi:e
0 to 100 Am s
101 to 200 Amps
Above 200 Amp:
Transformers
Signs
In
F�nal
This reduest vo�d
� � � � 0
Equ�pment Wited
Temporary Service
Lighting Fixtures
Electric Heatinq
Silo Unloader
Bulk Mllk Tank
iher (Speci�Vl
Other
Fee Feeders�Subfeeders p Fea Circuits
Oto30Am s Oto30Am
31 to 100 Amps 31 to 100 Am
Above 1o�—Am s Above 100_.Am s
Remote Control Circ. artial�Other Fee
Special Inspection g�y /i�A TOTAL FEE
r��5! (�
Date I, ths Electncal
. Inspector, hereby
certity thet the ebove
�^�P inspsction has bsen
�.Z�� mads.
This repuest void • � � 6'9
18 months from �} ��j' �j-J o
�e�� - Ci�� �'�o�% �
Q licensed Electncal Cont�actor
] Owner
Street A dress, Box or tj,Qy,t�No.
�� 1 _J�1.
Occupant IPRINT)
Power _Sudol �ern
Ele ri al Contractor (Company
� i`%L � /�, ,
Maillny Address IContractor or
>� �D �� �
AuMorized Sipnature lContrecti
1 hereby repuest inspectlon of sbova
slectricai work inatallsd at:
City
�i ,�.�� �i2.�1_
r MBkinp In t2i18tionl
��
r�r MakinQ Inst Ilatio�
LS
Pnone No.
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D/Li�-1 �I (�/S /O �
Contractor's License No.
�s �
�one Number