P - 82313�'� �� �� 6431 University Avenue Northeast (fr}2j 777-7885
FRIDLEY Fridley, Minnesota 55432 FAX (612) 571-1287
REQUEST FOR ELECTRICAL INSPECTION
"'X'" Below Wo�k Covered by This Request
Add pep. Type ol Bu�ldi�g Appliances Wired
Home Range
Dupiex Water Heater
Apt. Building Dryer
Commercial Bldg. Furnace
Industrial Bldg. Air Conditioner
c.._._ . ther �ec� v
�mpute Inspection Fee Below
Fss SarvicsEntroncsSiza
0 to 1 UO Am s
101 to 200 Amps
Above 200 Am :
Transformers
Signs
emarks ��
ouah-in
� F�nal � n `! �.si .. , �
v �i./ i t.)
Th�s reduest vo•id
This rgquest vo�d •
18 mo�ths trom
fee Feeders�Subfeeders �
Oto30Am s
31 to 100 Amps
Above 100�Am s
Remote Control Circ.
Special Inspection S
nequesl a�@ �Fif@ NO.
V g yV�
� Licensed Electncal Contractor
❑ Owner
: l -� ��� -
V i .� �
Equ�pment Wired
Temporary Service
Lighting Fixiures
Electr�c Heatmg
Silo Unloader
Bulk Mi�k Tank
ther ISPec�fvl
Other
fea CirCUits
0 to 30 Am
� 31 to 100 qm�
Above 100_Am a
Partial!Other Fee
)� TOTAL FEE
1, the Electricsl
. Inapacto�, hereby
csrufy thet ths ebow
c ,�\ insp�ct�on hss b�n
'��� msda.
�c� a 10153
�
iph-m Inspection
iuired? [�Ready Now � W�II N�ufy Inspec-
] Yes [] No �or Whe� Ready
� b�roby reqwat inspechon ot sbov �
slsctricsl work installsd ar.