P - 79451[��VUL,C,1 Fridley, Minnesota 55432 FAX (612) 571-1287
REQUEST FOR ELECTRICAL INSPECTION
"X" Below Work Coveied by This Reques�
Aatl 8eo. _ Tvue oi Bullaing Aoo��ances wlred
F
B
Service EnVen
0 t0 1 UO Am[
101 to Z00 A
Above 200
Transtormers
Final
rn�s .ea�es� �o,a
18 nnmhs hom
,��: ,eu�esi �o�a
ta montns irom
Eiec�caCC �va��or
� Occuoent
i e�e�
i '" . _.
ea��Pma�� w��aa
;mporary Service
ghting Fixtures
ec« ic Hea[mq
lo Unloader
dk Milk Tank
ne� Soerif�i
� � pmpr
�Sublenders b Fee Cucult
am 5 0 to 30 Am
7 Amos 31 to 10o a
�e 100—Am S �� Above 100_Amps
�te Control Clrc. Partial/Other Fee
ial InSpection - S��
TOTAL FEE
�
o��e
I, ihe Electn�al
. InsOactoq hp�eby
— cer�dv Ihet Ihe nbove
D"�� insoection M1as Eeen
Z _G,.� � meee.
� �N (o �b
� r �,�di/ . o`� S 00
C �. . .' .._i
No. qoup�-in �nspecbon
AeQUnetl? �Ready Nuw Q W�il N
❑Yes �ryp nbfy lnsoec-
W^ Q e
� hars�y reQUes1 �nsnecbon ol e�o�e
electncal work insialbd at�.
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��!���e No" /J �
iin.� �(�� j 9l /7
ta�lanon
���vacmr's L��ense
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