P - 77990REQUEST FOR ELECTRICAL INSPECTION
"X" Be/ow Work Covered by 7his Request
Add N�p Type o/ Buildinp APD��ances Wired
Home Range
�uplex Water Heater
Apt. Bw Iding Dryer
Commercial Bldg. Furnace
Industrial Bldg. Air Conditioner
F ther pec� v
arm
t r ueci v
Re lnspect�on Fee Below
F�e S�rvic�Entr�nc�Site
0to100Ams
101 to 200 Amps
Fe e
Transtormers s'. '
�,
Signs I ti =�
rk5
Fseders�Su6feeders �
Oto30Ams
31 to 100 Amps
Above 100_Am s
Remote Control Circ.
Specialinspection 5
2289
Equ�vment Wired
Temporary $ervice
Lighting Fixtures
Electric Heat�nq
Silo Unloader
Bulk Milk Tank
the� lS�ec�tvl
Other
Fes Circuits
0 to 30 Am
31 to 100 Am
Above 100_
artial!Other
� TOTAL FEE
Rouph-in Date
I, the Electrical
� Inspsctor, hersby
certify thet the nbovs
Final � �^�P insv�ction has bsen
�,.G��_,_.�� C �.�'-G mede.
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18 months hom
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Th�s request w�d �Q/
18 month5�;•from
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Request te Rre No. �quh-��Inspection ��ady Nuw [j W�it Not�f� Inspeo
l� ��3 �S ❑�es ❑No tor When Ready
Lice�sed E�ectricai Comractor I A���by nqueat inspecaon ot above
❑ Owner •Isctnul work install�d at: �