P - 79521�.a ■■ v■ 6431 University Avenue Northeast �6�t 777-7885
FRlDLE.Y Fridley, Minnesota 55432 FAX (612) 571-1287
REQUEST FaR EL�CTRICAL INSPECTION
""X'" Below Work Covered by This Request
Add Re Type of duilding Apv��ances Wired
Home Range
Duplex Water Heater
Apt. Building Dryer
Commercial Bldg. Furnace
Industrial Bldg. Air Conditioner
F Other pec� v
ema
arm
< < uecify
ite lnspect�on fee Below
Fss SsrviceEntrenesSizs
� to 1 UO Amps
101 to 200 Amps
Above 200 A
in
�
� Final
Th�s reQuest vo�d
18 nanths f�om
��7iws�w�a.. ,.�.
This request void
18 months from
t
Licensed El��ncaYContractor
Owner
Fee Feeders�Subfeeders F
Oto30Am s
31 to 100 Amps
Above 100_Am s
Remote Control Circ.
Special Inspection S
IP
�`t
�F,`�J
Equipment Wired
Tem�orary Service
Lighting Fixtures
Electnc Heating
Silo Unloader
Bulk Milk Tank
ther ISpec�tvl
Other
fea Circu
0 to 30 Am
31 to 100 �
Partial!Other F
TOTAL FEE
I, ths Electrical
Inapector, hersby
certify ehet the above
insDechon has bsen
inede.
,� 3 /�"7 1019 5��
�e No. Rough-�n Inspectioh
Required? �Ready Nuw Q Will Nolify tnspec-
❑ Yes � No �or When Ready
I hersby �equest inspect�on of above
electricsl work inatelled at �