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P - 77991r�u.c.-r � T J^ REUUEST FOR E!'�CTRICAL INSPECT�ON "'X'" Below Work Covered by This Reques� Add Il� Type ot Bwldinq Apo��ane�a Wi�sd Home ��„� Range Duplex Water Heater �ommerc i a I ndustr f a I I rte inspection fee 6e/ow F�e S��vic�Entrsne�Siza Otol00Ams 101 to 200 Amos -�.SL Air Conditioner ther pec� v � t� ■- �� = � �� Equipment Wired Temporary $ervice Lighting Fiztures Electric HeaUnq Silo Unloader Bulk Milk Tank ther (SDenfyl Olher feeders�Subteeders b Fea CirwUs Oto30Am s �to30Am � 31 to 100 Amps 31 to 100 Art Above 100_Am s Above 100_ Remote Control Circ. Partial!Other ial Inspection S �(7 _ �J(� . TOTAL FEE - ' - --- I, the Elsctrical � Inspector, hsrsby cerufy that the nbov Flnal ^tP � insp�ction has bsen '� made. Tbis reduest w�d �j ..18'months hom %. �Ct'% � `t 3 3 � �. ' �UCJ� -^ G� � [ � � .+. ----------------------- ��3�g+----- This request w�d 18 months;•.from ^ A ^ ,y�Q�Q� 1;; �, .� .r �� .� Request Oate Fire No. Rouph-�n Inspect�on ` Required? Ready Nuw [�' W�1I Notify Inspec- ��--" (9 '" C� ❑�es No �or When Peadv ]y� Licensed Electncal Contractor �Owner S�reet Add ess, 8ox or Route No. �i�� ,�� Occupant IPRINT) /L� t� L r L • %� ��' Pbwsr SuDD��M '��1 E�ectriwl Contractor (Companv Namel �—� Ma�linp Address (Coniractor p Ownsr .�� Authorued S�pnature IContractor Own 1 h�nby r�quest inspechon of above slectrical work �natalled at: ,�� lL,�iiZ Addres5 np Installanonl inp Instanation -rz�� (.�� Pnone No. �ra- s5�- Contractor's L�cense No. umber 7�