P - 84257REQUEST FOR ELECTRICAL INSPECTION
"X'" Below Work Covered by This Request
1 Add Rep. ype of Building Appliances Wired
. Home Range
Duplex Water Heater
Apt. Building Dryer
Commercial Bldg. Furnace
Industrial Bldg. Air Conditioner
Farm Other pec� y
t r pecify
'ompute lnspection Fee Be/ow
71 Fse Se�viceEntrenceSize
0 to 1 UO Am s
101 to 200 Amps
Above 200 Am :
Transformers
Sign
iemarks
ao�9n-��
f JY1/%y
Final ��
i•':
Equipment Wired
Temporary Service
Lighting Fixtures
Electric Heatinq
Silo Unloader
Bulk Milk Tank
ther ISpecifyl
Other
Fee Feeders�Subfeeders � Fee Circuits
Oto30Am s �to30Am �
31 to 100 Amps 31 to 100 Am
Above 700_Am s Above 100_
Remote Control Circ. Partial!Other
Special Inspection
� t q� ( S��`�`,�'�j TOTAL FEE
- -- i. �n. Eie�T.��ei
Inspector, hereby
certify that the above
�`��P inspection has been
?✓: .%'% mede.
This request vo�d '
18 nanths from
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T�,S request void ,��,�., ��, ��� 9 g 3
18 months from �
aquest Date
,0' P� ' ! /
Licensed Electncal Contractor
Owner
i�e No. Rough-�n Inspectio�
Repuired? �Ready Now Q W�II Notity Inspec-
❑ Nes ❑ No tor When Ready
1 hereby request inspection ot above
electrical work installed at:
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