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P - 77992� RE�UEST F.OR ELECTRICAL INSPECTION "X�� 8elow Work Covered by This Request Add p�P• Ype ot Buildinq ADO��anc�s wirsd - - Home Gav �^9e Ouplex Water Heater Apt. Bwiding Dryer Commercial Bldg. furnace Indtistrial Bldg. Air Conditioner Ferm ther vec� v 1 r Ueci(y t er ite Inspection fee Below F�e S�rvic�Entranc�Si:a Otot00Am s 101 to 200 Amps Above 200 Am , Transformers Signs �� Rouph-in Final � Thls reQuest w�d 18 nqnths f�om Fes Faeders�Subleaders 0to30Am s 31 to 100 Amps Above 100_Am <, Remote Control Circ. Specia� �nspection ����- f)�--C1� i �� ��55 Equipme�t Wired Temporary $ervice lighting Fixtures Electric Heatmg Silo Unloader Bulk Milk Tank ther lSpecityl p Fes Circwts Oto30Am 31 to 100 Am s Above 100_Am � Partial!Other fee 5 �, TOTAL FEE Date �. �hs Elactricel Inspector, harsby certity thst tha nbove �^�P inspsction has bssn �2— f/— a �i� made. �a:a.as_ �a� ----------:...w�,�.�..��.��r -� ��a.�;�sa.�r�4-----_ —..� �^ � Th�s reVUest w�d ` � ,H ��«�.�.�, \ '�' 2 � 5 5 Request Date Fire No. fiouph-m Inspecuon ReQuued? eativ Now [J' W��i Notify Inspec- � 2—. �� G� �Ves � �or When Ready � L�censCd Electr�cal Conir.lctor 1 h�r�by r�qu�st insDSCtion of sbove � pW�e� electrical work installed at: S�reet Address, Box or Route No. C�tv 3�{,� S a�'=-� l9-�'-�-- — ti�� le Occupent IPRINT) �one No. �-��,�, C��.��,� 63_a��-5�3f( Pbwer SupD��ar Address Elecer�cal Contractor ICompanv Namel Contractor's L�cense No. Ma�l�np Address (CoMractor Or Ownsr Makinp InstaUauonl AutAor�ied SipnaturY (Contractor Owner MakmQ Installauonl �one Number