P - 81667FRiDLEY 6431 UniFeidley, M nnesotar55432 FAX (612j 571-1287
RE�UEST FOR ELECTRICAL INSPECTION
"X'" Be/ow Work Covered by This Request
Add Rep. Type ot Building Appliances Wired
Home Range
Duplex Water Heater
Apt. Building Dryer
Commercial Bldg. Furnace
Industrial Bldg. Air Conditioner
Farm o�ner oer.� v
t r ueci V
:ompute lnspection Fee Below
u Pee SarvicsEntrsnceSiie
0 to 100 Am s
1 200 Amps
_Am ,
Transformers
igns
Remarks �
�
pough-�n
P�nal
Fee Feeders/Subteedars i
Oto30Am s
31 to 100 Amps
Above 100_.Am s
Remote Control Circ.
Speciai Inspect�on S
.1�';�j
Equ�pmant Wired
Temporary Service
L�ghting Fixtures
Electric Heat�nq
Silo Unloader
Bulk Milk Tank
iher lSpecifvl
Other
Fee Circuits
0 to 30 Am �
31 to 100 Arr
TOTA� FEE
� 1, th� ElectNCSI
. Inapeetor, hersby
csruty thet the ebove
��P insp�ct�on has besn
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Th�s request vo•�d — � � � � � �
18 nanths f�om
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Th�s reQuest vo�d '�+� /'�• �
,s ����g f,om � l�a�'�j � 10165
p4quest Da1e F�re No R h-�n In e ti
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/—�I'O/ Re❑quired? ❑ �Readv Now0W�11 NoUfv InsDec-
�es No to. When Readv
Licensed Elect�ical Contrqctor 1 h�rsby rsquast inspection of above
Owner slsctrical work inatalled at: