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P - 84766� r�VUl.t. Fridfey, Minnesota 4 1 0 0 0� REQUEST FOR ELECTRICAL INSPECTION "X" Below Work Covered by This Request Add Rap. ype ot Buildinq ADD��ances Wirad Equipment Wired Home Range Temporary Service Duplez Water Heater Lightin Fixtures Apt. Building Dryer Electric Heatin Commercial Bidg. Furnace Silo Unloader Industrial 81dg. Air Conditioner Bulk Milk Tank FBrm O�her pec� � �her (Soecitvl t r ueci y ther Other ompute lnspect�on fee Below fl Fsa SarvicsEntranceSize # Fea Feeders�Subfeeders p Fee Circuits 0 to 1 UO Am s 0 to 30 Am s � to 30 Am 101 to 200 Amps 31 to 100 Amps 31 to 100 Am Above 200 Am Above 100_Am s Above 100_Amps Transformers Remote Control Circ. Partial�Other fee Signs � Speciallnspection 5 �� Remarks TOTAL FEE f /��r t � ��lo� Rouph-in �°j� I, the Electricsl . InaDecto�, hsrsby certify that ths above ' Final Date '��spsction has besn. � ,�/� � mads. � Th�s request vo�d � � 18 nanths from ^ .,A `,�? "' �.�, � ° " _ �.� � , _.�.�-_ � ------------------__'-__- - ----- This request void • • t 0� 0 5 18 months from � �� /s o� � -� Request Date Fne No. Rouph-�n Inspection Repuired� �Ready Nuw Q W�11 Nolity Inspec- �- �� '�� ❑ Yes ❑ No tor When Ready � UcenSed ElectnCal ConVaCtor 1 hersby rsquest inspectlon ot above Owner electrical work inatallsd at: Street Address, 8ox or Ro te No. Citv ��r � ��a�' ' 2� -2�oL�. Occu�Ii4RINT1 Pnone No. 1 >�� 1� 1 �(di � Power SupD��er Ad ss -S � Ls �.� � ; o� Elect��cal ontractor lCompany Namel Contractor's License No. �� ? � � : Mailinp Addr IContractor w Owner Makiny Instailauon) �� Authorized Sipnature (Comractor Owne� Mak��p Installationl Phone Numbe� S� - b�� . '"� -s- � t� � )