P - 83895n ey, inneso - � � Q � ^
REQUEST FOR ELECTRICAL INSPECTION L
""X'" Below Work Covered by This Request
Add pep Type o( Buildinq Applia�ces Wired Equipment Wired
Horne Range Temporary Service
Duplex Water Heater Lighting Fixtures
Apt. Building Dryer Eiectric Heatin
Commercial Bldg. Furnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Fd�m Other pec� v �her (Soecifyl
t r pecify Iher Other �
Compute lnspection Fee Below
a Pse SarvicsEntrancsSizs q Fee Feeders�Subteedars p Fee Circuits
Otol00Am s �to30Am s 0 to30Am
101 to 200 Amps 31 to 100 Amps 31 to 1 UO Am
Above 200 Amps Above 1d0_Am s Ahove 100_Amps
Transformers Remote Controt Circ. Partial!Other Fee
Signs Special lnspect�on � _
S +�C O� TOTAL FEE
Remarks / � I / '� �� �� �
l
fiouqh-in ��1e I, the Elactrical
. I�spector, hereby
certify that the above
Final � O �^�P inspaction has been
_�---� i� ..�-� �%c meds.
Th�s reQuest vo�d
18 nanths fror�"� ` -
�7�'�'f„s
This reques[ void �
18 months trom
Request Date Fire �
10 --�? - 9�
� Llcensed Electncal Contractor
Owner
Street Address, Bo or Route No.
C� � ��� � U��-�. �
Occupant I INTI
S
Power Suppl�e� , .
jvS
Electncal Contractor ICompany Namel
l�
�� 9.�"�1 � � 3 2
"�1� .��� �'�� ! .
Rouph-in InspeCt�on
iieQuired? �Ready Nuw � W��I Noufy I�spec-
❑ Yes [� No tor When Ready
1 hersby request inspect�on of above
electncal work inatalled at:
City
� � �����
Pno�ie No.
A
Ma�l�np Ad ess (Contractor or Owner Makinp tnstailationl
�
AuMoraed Sipnature (Contracto� Owner Makinq Ins[allation
� t'".. �._ � j .
1i.✓ C� � ,� F ,i
�%1�I� U L V
ontractor�s L�cense No.
umber