P - 84148, i nesoa 10044
� REQUEST FOR ELECTRICAL INSPECTION
""X'" Below Work Covered by This Request
Add Rep. Type ol Building ApO�iances Wired EquiDment Wired
Horne Range Temporary Service
Duplex Water Heater Lighting Fixtures
Apt. Building Dryer Electric HeaUn
Commercial Bldg. Furnace Silo Unloader
Indi�strial Bldg. Air Conditioner Bulk Mllk Tank
Farm � Other pec� v Other (Specifvl
t r yecify ther Other �
Compute lnspection Fee Below
a � Fee ServicsEntrancsSizs k Fee Feeders�Subteeders b Fee Circuits
0 to 100 Am s � to 30 Am s 0 to 30 Am
101 to 200 Amps 31 to 1 UO Amps 31 to 100 Am
Above 200 Amps Above 100-Am s Above 100._Amps
Transformers Remote Controi Circ. Partial!Other Fee
Signs �� , Special Inspection �� �
S L (� TOTAL FEE
Remarks ��`j j� � ' i
�'l�/Clil�1 / ��r��� �
Rough-in
Date �, the Electrieal
. Insvecto�, hereby
cartify that ths above
fmal �^�P inspectio� hes bsen
__� made.
This reQUest void
18 n�onths 1,or�,.
�' � s,� ``
�7 ,.:_.
---------------�-------------------- ,s-o� � 1 � � �
This request vo�d � �p y � � �.
18 months from . �S�x
' ppa�,3
I Request Date� � Fi�e No. qoouQhe�n�lnsp❑ect+o� �Ready Now Q W�i� Noufv ��spec-
� tor When Ready
� Ves No
I � Licensed Electncai Contractor
�Owner
'T Street Address, Box or qpute No.
Occupa�tlIPRINTI
�
Power Suooli.er"\
Electnc Contractor ICompany Namel
�(-C�l�f`J�:
Ma�l�nq Address IContractor or Owner
^S �-��-.1.�
Autho�aed Sipnature (Comractor�
C�'9 ,
f _• ` .
1 hereby request inspectlon ot above
electrical work inatalled at:
City �.
A dd
np Instailation)
ik�no Installati<
Pno��e No.
Contractor's License No.
one Number