P - 80410FRlDLEY 6431 UniFe+dley, Mir�nesotar55432 FAX (6�571•1287
REQUEST FOR ELECTRICAL INSPECTION
""X�" Below Work Covered by This Request
Add Rep. TyDe ot 8uilding Aou��ances Wired
Home Range
Duplex Water Heater
Apt. Building Dryer
Commercial Bldg. Furnace
Industrial Bldg. Air Conditipner
Farm
t er ueci v
ite lnspect�on fee Below
Fsa SarvieeEntrsnceSizs
0 to 1 UO Am s
l,ql to 200 Amps
ema
in
Final
....�
fae Feeders�Subfeede�s
Oto30Am s
31 to 100 Amps
Above 100_Am <
Remote Control Circ.
Speciallnspect�on
i.:�� �
EQu�Dment Wired
Temporary Service
Ughting FixtureS
Electric Heatinq
Silo Unloader
Bulk Milk Tank
iher ISDec�fyl
n�her
M fee Circuits
0 to 30 Amos
31 to t00 Am s
Ahove 10a_Ampa
Partial!Other Fee
S�%� TOTAL FEE
Daie �, ths Eleevieal
. Inapector, hersby
certNy thst �hs nbovs
�^�P _ _ i�apsction hsa basn
Th�s repuest. vo•�d ��� �.
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This request vo�d � � � � O � � �
18 months from
Fequest te fi�e No. Rouph-�n InsDectlon
�/ IteQuned? �Ready Muw Q W�11 Not�ty Inspec-
/`� � Q Yes � No tor When Ready
licensed Electncat Contractor 1 heraby reVuest inspechon ol Above
❑ Owner slectricsl work installed ar. .'