P - 84181Fridley, Minnesota 5543 A 12) 571-1287 ��� B y
t�QUEST FOR ELECTRICAL INSPECTION 6� /
"'X'" Below Work Covered by This Request
Add Rep. Type of Building ApOliances Wired Equlpment Wired
Home Ra�9e Temporary Service
Duplex Water Heater Lighting Fixtures
Apt. Building Dryer Electric Heatin
Commercial Bldg. Fumace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Fdrm O�her peu v Other lSpecityl
t r peci(y ther Other -
Compute lnspection Fee Be/ow
q � Fse ServiceEntranceSize k Fee FeedersiSubteeders b Fee Circuits
OtolUOAm s Oto30Am s Oto30Am
101 to 200 Amps 31 to 100 Amps 37 to 100 Am
Above 200 Amps Above 1�—Am s hove 100_Amps
Transformers Remote Control Circ. artiai!Other Fee
igns
�k5
i-��
Final �
This reQUest vo�d
18 nan�hs from` ` � � �
�/ �
"_------ �
This request vo�d
18 months from
FiP.Qu¢St UBIB
/ � /�� ���
Ucensed Electncal Contractor
� Owner
Street Address, Box or Route No.
IPRINTI
> ,� � f
Qi�er �
Electr . I Contractor ICompan
�Ui. J - �
Maili p Addre s(Co tractor o�
AuMorized Sipnature IContract
Special Inspection S�S.
% � ��_:%�� r�
Date
Dnte �
_ � �Zd /
i re
TOTAL FEE
I, the Electricsl
Inspector, hersby
certify that the above
inspection has bean
mede.
50�� � V � /
(..�
Rouph-in�InsDect�on �qeady Nuw pw�ii Nolify Inspec-
ReQuired
❑�es ❑No [or When Feady
I hereby request inspec6on ot sbova
electncal work installsd at:
CitY
�n � r� - �� �
Pnone No.
� � � i_s/
r Makinp Instaij Uon)
iv� ` L.�
�er Makinp Installau�
��2�� �J/ 1/,
Contractoi�s License No.
umber