P - 82709rKIULt.Y Frid�ey, Minnesota 55432 FAX (612) 571-1287
REQUEST FOR ELECTRICAL iNSPECTION
""X" Below Work Covered by This Request
Add Rep. Type ol Building ApD�iances Wired
Home Range
Duptex Water Heater
Apt. Building Dryer
Commercial Bidg. Furnace
Industrial Bidg. Air Conditioner
F rm � Other pec� v
a
t r peci y
ute lnspection fee Below
Fse ServicsEntrsnc�Sizs
0 to 1 UO Amps
101 to 200 Amps
Above 200 Amns
marks
ugh-in
F�nal
Fee Feeders/Subfeeders A
Oto30Am s
31 to 100 Amps
Above 100_Am s
Remote Control Circ.
Special Inspection S
r� _ -- —
�t . i
Equ�pment Wired
Temporary $ervice
Lighting Fixtures
Electric Heatlnq
Silo Unloader
Bulk Mlik Tank
Iher 1SpeCifyl
Fee Circuita
� to 30 Amos
31 to 100 Am s
—�� Above 100_Am ;
Partia��Other Fee
��, �� TOTAI FEE
�1e I, th� Elsctrieal
Inspsctor, hersby
cartifv that ths ebovs
'��P insp�ction has baen
�.�� msd�.
rnis repuest� vo - '
18 nanths from � ��• � �
This request vo�d • U` D � O O� O
18 rrwnths from �
�( O
Request Date FI�e No, qauph-i� Inspecuon
���� Ae4u�retl? �Reatly Nuw ❑ W�II NoUfy tnsPec-
❑ Yes ❑ No ror When Ready
❑ licensed Electncal Contractor
Owner � h�rsby �equsst inspectlo� of above
alsctrical work installsd at: