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P - 81653
REUUEST FOR ELECTRICAL INSPECTION ""X' " Be/ow Work Cavered by This Request �''�� �`� %}c(� Add ��c• Type o1 6uHdinp ApD���^�ss Mlirsd Home ��9Q Duplex Water Heater Apt. Bwtding Dryer Commercial Bldg. Furnace InduStrial Bldg. Air Conditioner Farm ther nec� v t r uec� v t er ompute /nspect�on fee Below 08976730 Equ�Dment Wired Temporary Service Lighting Fixtures Electric Heat�n Silo Unloader Bulk Milk Tank ihei ISDeC�ly) Otner a F�• S�rvie�Ent�anc�Sis• fl Fse Fsedera�Sublesdera M fas Circults Utot00Am Oto30Am"s Oto30Am 101 to 200 Amps 31 t0 100 Amps 31 to 100 A Above 200 Am Above 100—Am s ' Above 100�.Am Transformers Remote Control Circ. Partial!Other Fee Signs Special Inspect�on g 0,�^ TOTAI FEE e�rks J - �ate Rouph-in ��� � 1, ths EleGtrie�l G t�spsctor, h�rsbv c�rtifv �hst tM abov� F�nal D�IP insMetion Ms ���n Z�_G � m�d�. Th�s �equest w�d � � �� � � 18 months hom . — — � ---- _ — — p�F1�E t1�E qILY Thia rpued void 18 monlhs from vqlidatio; dafe p!inted in fhis box. ��fi S� �Illllll��lllllll�lll�ltl�lll���� �� � � *os976730* .�aas PLEASE PRINT OR TYPE Requesf Dafe q Rough-in inapectian required? �.Yes ❑ No Inspecfion Ofher Than Rough-In: ❑ Ready Now � W�II Call ..� /� � aV� � You must call the inspettor when ready Dare Ready: I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: . �:,, r,..Jm ��V! Yfvv j cTeTF ROARD C�PV