P - 83332._— --- ........� .. oo.,�o .,u+�c rr�n �o ic� ai i-iroi
REQUEST FOR ELECTRICAL INSPECTION
"'X'" Below Work Covered by This Request
Add Rep. yve ot Builtlinq Appliancea Wirsd
Home Range
Duplex Water Heater
Apt. Building Dryer
Commerciai Bldg. Furnace
Industrial Bldg. Air Conditioner
Farm ther oec� v
t r peci y
'ompute lnspection Fee Below
� Fsa SsrviceEntrenc�Si:s
0 to 1 UO Am
101 to 200 Amps
Above 200 Am
Transformers
Signs
3emarks ,.�
i�%�
4o uph- i rt �
6itS'T" � -
Th�s r �st vo�d
18 no�i � +� �
�� J
This request vo�d �
18 months trom
/0%
licensed E�ectrica� Contractor
Owner
fee Feeders�Subfeeders
Oto30Am s
31 to 100 Amps
Above 100_Am
re
�J
Equlpment Wired
Temporary $ervice
Lighting Fixtures
Electric Heatinq
Silo Untoader
Bulk Milk Tank
iher ISoecifvl
Circuii
0 to 30 Am[
31 to 100 A
cial Inspection
5��� TOTAL FEE
., � r
--�- I, th� Electriul
Insoeetor, h�r�by
�tify thst th� abov�
D'A�P. ��sDection has been
C)•�� mede.
� �•�� � 10089
r�
ipn-�n inspecnon
�u�red? �Ready Nuw QW�II NaUfv tnsPec-
� Yes � No . tor When ReBdY
I b�nby nqwst inapscdoo of �bow-
sl�ctrical work install�d �t: