P - 80974�"' '' �' 6431 University Avenue Northeast (�f-t2) 777-7885
FiliDLEY Fridley, Minnesota 55432 FAX (&12) 571-1287
REQUEST FOR ELECTRICAL INSPECTION
"X'" Below Work Coveied by This Request
Add pep. ype ot Building Appliances Wired
Home � Range
Ouplex Water Heater
Apt. Building Dryer
Commercial Bldg. FumaCe
Industrial Bldg. Air Conditioner
F Other Pec� v
arm
t r peci y
ite lnspect�on Fee Be1aw
Fse Sa�vics Entrsnee Size
0 to t UO Am s
101 to 200 Amps
Above 200 Am a
Transformers
Signs
M ema r ks /
Aough-in ` /
f�nal
TAis request va�d
�8 nanihs f�om
��..���..��_..�___ _��.�as�.:�
This repuest vo�d
18 mpn�hs from
Aaquest Date /� F�re
� `�� L
licensed E�ectncal Contractor
Owner
Fee feaders/Su6feeders p
Oto30Am s
31 to 100 Artips
Above 100 _ Am s
Remote Control Circ.
Speciallnspection $
} r v .f •
h .: � ��
Equipmeni Wired
Tem�rary Service
lighting Fixtures
Electric Heat�ng
Silo Unloade�
Bulk M�Ik Tank
ther (Specitv!
nlher
Fee Circuits
0 to 30 Am
31 to l00 Am s
Above 100_Amps
Partial!Other Fee
>
� TOTAL FEE
ate
1, the Electrical
- Inaosctor, hersby
csrfify tAst tbs �bovs
`��P insDection hss besn
���,��J mpds.
`�� 10128
6 Q�/
�pA-in InSDection
�u�red? �Reativ Npw [� Will Nolifv Ins1
]�es �No tor When R88dY
� hersby rsqu�st inspect�on of abova
slectrical work inetalled at: