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P - 82711..,._� ,,,. �,, ,., ,�,.,,o .,�.�� ,,,. ,�,�, .,, ,-,�,., '� Q � .�3 7 REQUEST FOR ELECTRICAL INSPECTION ""X" Below Work Covered by Thrs Request Add Rep. e ot Buildinq ApD�iances Wirsd Equipment Wired Home Range Temporary Service Duplex Water Heater Lightin Fixtures Apt. Building Dryer Electric Heatin Commercial Bldg. Furnace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank Farm o�ne� peci v ther (SPecify) t r peci v tner otner � Compute lnspection Fee Below u Fse SsrviesEntrsnesSizs # Fee Feeders�Subfeaders p fee Circuita Oto100Am 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. '�� Partial�Other Fee Signs Special Inspectio� I Remarks �,. /� �� ` / � e S /�O� TOTAL FEE �/C� CJ Rouqh-in Date �. �h� Eleetrieal lospsctor, heroby csrtify thst th� ebov F�nal 0'��P inspeetion I�ss baan _ d.— m�de. Th�s request vo�d A� A'�� 18 nanths from �r f1 A1 � sEa/61Q� , 10 0 51 This request vo�d 18 months trom P�- Rerquest Date Flre No. Rouph-in Inspecuon Required? �Ready Now � Will Not�fy Ingpec- p� ' — Q Yes ❑ No tor When ReadY ❑ Licensed Electr�cal ContrTCtor 1 h�r�by rsquest inapection of abov� ner slsetrical work installed at: Street Addross, Box or oute No. Citv '��5" � � 1��. 2� Occu t IPRINT) � Pnone No, Power Suppl�� . Add S l�-� �Jl DIJ Electrical ntractor ICpmpany Name) Contractor's license No. C.JCJ J�J Ma111np Address Contractor w Ownsr Makinp Instailallon) Author�zed Sipnatur� (Contractor Ownsr Makinp Installationl Phone Numbe � ' � 25908