P - 79507�""� �� v� 6431 Universiry Avenue Northeast F6a-2j 777-7885 .� ,
FRiDLEY Fridley, Minnesota 55432 FAX (612) 571•1287 f �.� ��'J J
REQUEST FOW ELECTRICAL INSPECTION
""X'" Below Work Covered by This Request
Add Rep. Type ol 8uiiding Appliances Wired Equ�pment Wired
Home Range Tem��orary Service
Duplex Water Heater Lighting F�xtures
Apt. Buiiding Dryer Electric Heatin
Commercial Bldg. Furnace Silo Unloader
industnal Bldg. Air Conditioner Bulk Milk Tank
Fafm . Other pec� v Othe� ISnecifyl
t r UecifY ther p�her
Compute lnspection fee Be/ow
p Fse Sa�vicsEntrancsSize p Fee Feeders�Subfeede�s +� Fee Circuits
0 to 1 UO Am 0 to 3Q Am s � to 30 Am s
101 to 200 Amps 31 to 100 Amps 31 to 700 Am
Above 200 Am s bove 100_Am s Ab ve 100_Am s
Transformers mote Control Circ. � Partial!Other Fee
Sign Special InspecUon S �
Remarks f ��
TOTAL FEE
Rough-in . _ Date I, ths Electrical
. . Inapector, hersby
certify that th� ebovs
F�nal �ji��� �nspsction has bsen
Gi da.
7his request vo��d
18 npnths hom � �
T�.S ,�q�e5► �o,d # 1019 6 �
18 months }rom
�i.,° .33ao a -oo
Request te fi�e No. HouBh-�n Inspect�on
ReQuired? �Neady Nuw � Wi11 NoUfy tnspec-
��p� � O� ❑ �eS ❑ No �or When Heady
❑ L�censed Electrical Contractor 1 h�rsby �equest inspection ol sbove
� �OW�e� slsctrical work inatallsd at:
Street Ad�,a s, Box o,Rout o.• �ity
S S t.c_� N � �j
O pent (PAINTI Pnone No.
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Power SupDlier . Ad s
LS 0 `T� > l% �
Electncal Contracto� �pmpany Name) Contractor�s L�cense No.
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Malllnp Address IContractor Ownar Makinp Ingtailat�on)
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AuMorized S�p�ature (Contractor Owner Mak��p Installauo�l Phone Numbe,i _