P - 82897KtoUEST FaR ELECTRICAL INSPECTION 05325048
"X" Below Work Covered by �his Reques� ,�r'�-�. ;�,-c j,.J�.
A d M TYps o1 6uildinp ApO��anc�s W1rsd Equ�pmsal Wirsd
Home Range Temporary Service
Duplex Water Heater L�ghtin Fixtures
Apt. 8wld�ng Dryer Electric Heatin
Corrmercial Bidg. Fu�nace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Mllk Tank
Farm ther aen v �her lS�ecit�l
1 r ueci y t er Other
ompute lnspect�on Fee Below
N F�e S�rvic�Entranc�$i:• M Fes fesders�Su6teeders M Fee Circu�ts
OtolUOAm Oto30Am s �to30Am
101 to 200 Amps 31 to 100 Amps 31 to 100 Am
Above 200 Am Above 100�Am s Above 100�Am s
TranSformerS Remote Control Circ. Partiat!Other Fee
Signs Speciallnspect�on
errerks A S �,� TOTAL FEE
�f-N � i1/ i5. �„z 'T" r Nh/� �t L t/�-
Aouph•in Dale �. �tie El�ctric�l
� � � InsPecto�. h�rsby
urtily thst th� abov�
final On�e ao�etion has SNn
�-�.9— �.d..
Thls reQuegt vo�d
, a �b��ns r,«„ ,�( �,G` % 3 7
C�RCE IME OIN.Y This nqunf vad 18 months 6om volidafion date printed in ihis ox.
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* � 5� 2 5 � 4 8�K PLEASE PRINT OR TYPE
Request �°�e Rou h-in ins on r uired? Yes
g pecfi eq � ❑ No Inspection Other Than Rough-In: ❑ Ready Now Will Coll
� 8.� (You musf call the inspactor when ready� Date Ready:
I, �icensed contractor ❑ owner hereby request inspection of the above elechical work at:
Job Address (Shcet. Box, w Route No.) Ciy Zip Code
r � � �� � � ���3�
Seclion No. Township Name a No Range No. Fire No. Couny
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Occupanf „ Plrone No.
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Power Supplier � A�
LS o �1 �l �
Elechical Conhncror (Company Name) Conhactor ticense�No. Masfer Lic. No. (Plonf Elect. Only)
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Mailin Address �Contracror w Owner P rmirg InstalkAion) ` �
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A�thorized Si (Con or Perfnrming Installafion) Phone No.
26�,�►� I� �
EB-00001 1/96 �ATE BOARD COPY - SEE MISTRUCTIONS ON BACK OF YELLOW COPY