P - 83924r Fridley, Minnesota 55432 P,.. 7i-1 i?
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REQUEST FOR ELECTRICAL INSPECTION
"'X'" Below Work Covered by This Request
Add Rep. Type o1 Bui�ding Appliancea Wired Equipment Wired
_ Home Range Temporary Service
Duplex Water Heater Lighting Fixtures
Apt. Building Dryer Electric Heatin
Cortmercial Bldg. Furnace Silo Unloader
Industrial Bidg. Air Conditioner Bulk Mllk Tank
Fdfrtt - Other peci v ther ISpecify�
t r peclfy ther Other �
Compute lnspect�on Fee Be/ow
tt Pee SarviceEntronceSize # Fee Feeders�Subfeaders p Fee Circuits
0 to 1 UO Am s � 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 �-- TOTAL FEE
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Remarks ���,�� � � � ��
Rough-in ���e t, the Electricsl
. InsDector, hereby
certi}y lhat lhs nbove
F�nal -�-�..� /� �^�P p insDection has been
// _ / it/ % % mede.
Th�s request vo�d �� �
18 nionths f����+� . �
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This request void �
18 months from
Request Date
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� Llce�sed Electncal Contractor
�Owner
Street Address, Box or Route No.
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Occu IPRINTI
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Power $uppli .
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Electnca Contractor ICompanv Name;
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Mail�nq Addr s IContractor or Owner
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AuMonzed Sipnature lContractor Owi
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�ph-in�InSpCCt�on �Ready Now Q W��� �`1�lify Inspec-
uired
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I hersby request inspection ot sbove
electrical work installed at:
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. Contractor's License No.
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r Mak�np Instailati
Number
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