P - 83940�- -r1VULti Frid�ey, Minnesota 55432 FAX (6
REQUEST 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 Bidg. Furnace
Industrial Bldg. Air Conditioner
� Fdfm - Other peu y
� 1 r UeCify ther
ite lnspection Fee Below
Fee SarvicsEntrancsSizs
0 to 1 UO Am s
101 to 200 Amps
Above 200 Amoe
rks
i-in
, Final
� This repuest vo�d
� 18 nqnths from
I This request void
18 months from
1���5
Equipment Wired
Temporary Service
Lighting Fixtures
Electric Heatinq
Silo Unloader
Bulk Milk Ta�k
Othe� ($vecify)
Olher
Fee Feeders�Subfeeders b Fea Circuits
Oto30Am s �to30Am
31 to 100 Amps 31 to 100 Am
Above 100_Am s Above 100_Amp<,
Remote Control Circ. Partial!Other Fee
Speciai Inspection S
�� ; (1� TOTAL FEE
Date �, the Eleetrieal
. Inspector, hersby
certify that the wbove
� Dnte ��spection has bsen
// f1�t�. —. % _/�r%�. meds.
'—_._----'--^---------------------------------
� a����10�35
� �r q 7
a 50�
I Request Date Fire No. Reqyhe�n�InsDeceion �qeady Now Q W�II Nolify InsPec•
j�' �� -� � Yes ❑ No lor When Ready
�Licensed EIecV�cal Contractor
❑ Owner
Street Address, Box or Route No.
�L�/7L
Occupa�t IPRtNTI
Power Supplier .
(�
1 hersbV requsst inspecNOn of above
electrical work inatalled at:
C ity _
Address
Ele �ical Contractor ICompanv Namel
�L.CA� S� �t_ � ���,/�11�
Malllnp Address IContr ctor w Owner Makinp Instailat�on
��� r f . �C���,,,��� ��� F2 �
Authorized Sipnature IComractor%�Ow�er Maki�p Installati
Pnone No.
[A�� L..al (/ `
Contractor�s License No.
umber