P - 81044�-'� �� v��/ 6431 U�iversity Avenue Northeast -t��1 ��� ��a�
��DL„L` Fridley, Minnesota 55432 - FAX (612) 571-1267
REQUEST FOR EIECTRICAL INSPEC710N
"'X'" Below Work Covered by This Request
Add ReD• Type ot Bwiding ApOliances W�red
Home Range
Duplez Water Heater
Apt. Building Dryer
Commercial Bldg. Furnace
Industrial Bldg. Air Conditioner
F3rm - ther pec� v
t r VeCi y t@r
Compute lnspect�on fee Below
p Fse ServicsEntrsnc�Sizs u Fea Feeders/Subfeeders p
OtolUOAm s Oto30Am s
101 to 200 Amps 31 to 100 Amps
Above Z00 Amps Above ��—Am s
Transformers Remote Control Circ.
S; Special I�spect�on S
�
Remarks .� ��
Rouah-in
F�nal
1�.,';��
Equ�pment Wired
Tem�orary Service
Lighting Fixtures
Electric Heat��g
Silo Unloader
Bulk Milk Tank
O�her lSoec�N�
Other
ate
D:+te
�O �
Fea c�.����s
0 to 30 Am �
31 to 100 Art
Above 100_
artiai!Othei
� / TOTAL FEE
1, the Electricsl
Inapeetor, heraby
certlfy tF�st ths �bovs
inaosction hss bsen
�Th�s repuesi vo•id � �
18 nanths �pip.� � ^
� � lJ
� ���������� � -������-..-az- . .. ����..�
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Th�s request vo�d / ��� 10125
18 months from ��
Fequest Date f��e No. Rough-�n inspect�on
Requ�red? �Ready Now Q W�11 Nouf� tnsoec-
�� �`+% ❑ �es ❑ No �a� When Ready
�l�censCd Electncal ContrRCtor 1 h�rsby rsquest inspechon ot sbove
Owner slsctrical work inatalled at: