P - 83997r� Fridley, inneso a
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REQUEST FOR ELECTRICAL INSPECTION
"X'" Below Work Covered by This Reques�
Add Rep. Type ot Building ApD�iances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Lighting Fixtures
Apt. Building Dryer Electric Heatin
Commercial Bldg. Furnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm O�her peu v Oiher ISoec�f�l
1 r uec�fv ther Oiher �
'ompute lnspection fee Below
t� Fse SsrvicsEntranceSize
0 to 1 UO Amps
101 to 200 Amps
Above 200 Amp;
Transformers
Signs
Remarks
Rouph-in
Final
This request void
18 nanths h� h- � �� ..�_
V
l C.�
Th�s request vo�d •
18 month5 frOm
squest Date I Fire
� >�-�y 9�
Ucensed Electncal Contractor
Owner
Fee Feeders�Subfeeders p Fee Circui
0 to 30 Am s 0 to 30 Am
31 to 100 Amps 31 to 100 �
Above 100—Am s Above 100.
Remote Control Circ. Partial!Oth
Special Inspection
S �� (�(� TOTAL FEE
te
D:� te
�- �%
I, the Electricel
Inspecto�, hersby
certify thet the above
inspection has bsen
mede.
a 7� ���38
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�. (J�
igh-m Inspection
�uired� �Ready Now � W�il Noufy tnsDec-
]Yes ❑No tor When ReadY
i heroby re4uest inspectlon of ebove
elsctrical work installed at: