P - 77985RE�UEST FOR ELECTRICAL INSPECTION
""X" Below Work Cove�ed by This Request
Add MeD• Type ot Bwldinq ADD��antsa Wlrad
Home Range
�up�ex Water Heater
Apt. Building Dryer
Commercial Bldg. Furnace
Indiistrial Bldg. Air Conditioner
Iher Deu v
Farm
t i uec�fy
ite lnspection Fee Below
F�e S�rvic�Entrane�Si:•
Otol00Am s
101 to 200 Amos
l I 1 "9"s
Remarks
Rouqh-in
F�nal
This repuest w�d
16 nqnihs hom
Fesders�Subfesders
0 to 30 Amps
31 to 100 Amps
Above 100_Amp<,
Remote Control Circ.
Speciallnspection
2275
Equipment Wirsd
Temporary Service
Lighting Fixtures
Electric Heat�nq
Silo Unioader
Bulk Milk Tank
ther ($Decifv)
Other
p Fee Circwts
0 to 30 Am
31 to 100 Am s
Above 100_Am !
Partial!Other fee
S OG TOTAI FEE
Date
I, ths Elsctricsl
Insosctor, hereby
certify that ths nbove
�'��P i sv�ction has bsen
���2 de.
� r�. i� � f� �.� i.r�v �s,rs s�ar i-rrrc��rcvvr.: �.. r-r� � �.:a`-�s� r� �� �
C'3�%� °��
Th�s request void � �
18 months�...from � ^ r� �+
`-'v " l �"� 4 � a±
Res4ues ��_O� Flre No. � he�n�lnspOection �Readv Nuw [jW�ii Noufv Inspec-
�es No tor When Readv
Lice�sed Electr�cat Contractor 1 h�r�by request inspecc�o� ot sbovs
❑ Owner •Isctncal work instalhd st: -