P - 82268L.l I I V��/ 6431 University Avenue Northeast (8+�) 777-7885
��D�L[ Fridley, Minnesota 55432 FAX (612) 571-1287
REQUEST FOR ELECTRICAL INSPECTION
"'X'" Below Work Covered by This Request
Add peD Type of Building Appliances Wired
Home Range
Duplex Water Heater
Apt. 8uilding Dryer
Commercial Bldg. FurnaCe
Industrial Bldg. Air Conditioner
Farm otner pec� v
t r uecify t er
Compute lnspection Fee Below
p Fss SsrviceEntrsnceSize a Fee Feeders�Subteeders p
0 to 1 UO Am 0 to 30 Am s
101 to 200 Amps 31 to 100 Amps
o �0 Am s Above ��-Am s
a mers Remote Control Circ.
Signs Special�nspection S
Remarks � � � ,�.. �. % n �.i1 A f '
Moupn-m
F�nal
Th�s reduesc vo�C
��
Th�s request vo�d •
18 months from
Request Date
-�o-ao
Lice�sed Electncal Contractor
] Owner
i u' i .i L
Equ�pment Wfred
Temporary Service
Lighting Fixtures
Electr�c HeaUng
Si lo Unloader
Bulk Mi�k Tank
iher ISoec�fvl
Other
Fee Ci�cui
0 to 30 Am
31 to 100 �
Above 100.
artial!Oth
/y� TpTAL FEE
"" I, ths Electrical
. inspector, hsrsby
ce�tify thpt tbs ebovs
� � Date insP�ction hss been
,� ^Lal msds.
/
���i�����
�D� O
�� 10152
f�re No. Rouph-in Inspection
Required? �Ready Nuw Q Wi�l No1�fv Inspec-
�yes �No [or When Ready
1 h�r�by requast �nsPact�on ot above
slsctrical wo�k inslalled at: '