P - 84186REQUEST FOR ELECTRICAL INSPECTION
'"X'" Below Work Covered by This Request
Add Rep. Typa o� Buildinp Appliances Wsred
OfTle R2f1gQ
Duplez Water Heater
Apt. Building Dryer
Commercial Bldg. Furnace
Industrial Bldg. Air Conditioner
Farm Other pec� v
t r pecl y ther
Compute lnspection Fee Be/ow
� : � �
Equlpment Wired
Temporary Service
Lighting Fixtures
Electric Heatinq
Silo Unloader
Bulk Mllk Tank
Iher (Spec�fy�
Other
# � Fsa SsrviwEntranceSizs k Fee Feeders�Subteeders p Fee Circuits
0 to 1 UO Am s � to 30 Am s
101 to 200 Amps 31 to 100 Amps
�k5
i-in
IFinal /
Th�s reQuest vo�d e
18 nionths fro��� (����
�
� :rt..r�—�rr.araarcrrr�a
This request void •
78 months from
Am s Above 100_Am s
Remote Control Circ. —
Special Inspection S ��
.,.� . r
/ �. _�`� .-r�..i Y-.. �. ..
D�te
.i^1 D n t e
' ` �� :L!—;
0 to 30 Amos
31 to 1 UO Amps
Above 100_Amp;
Partial!Other Fee
TOTAL FEE
1, ths Electrical
Inspector, hersby
certlfy that the nbove
i�spection has bsen
mede.
,� � ���� � ��l � � � 4 s
/� �
Request Date Fire No. Rouph•�n Inspection
ReQuired7 �Ready Now Q W�II Noufy tnspec-
��. ❑ �es ❑ No tor Whe� Ready
� Licensed Electncal Contractor
Owner
Street Address, Box o� R te o.
S
Occupa� INT)
�( Vl�
� Power uDPlier � _ .
�Electncal ontractor ICompan Namel
�.E�--��,��_
Mailinp Addr Contractor w Owner
�i��`Y�l
AuMorized Sipnawra IComractor�
1 hereby rsquest inspacNOn ot sbove
alectNCal work inatalled at:
� City
�,�..,�
Pno�ie No.
np Instailat�on)
�k��Q Installation
,s /�,%L��,�� -�ii ��
Contractor's license No.