P - 78851RE�UEST FOR ELECTRICAL INSPECTION
'"X'" Below Work Cove�ed by This Request
Add R�o• Type o1 Buildi�q Apv�iancss Wirsd
Home �^�
n...,io„ Water Heater
Commerci al
Industrial B
ite Inspectron Fee tle�ow
Fea S�rvic�Ent�ane�Si:•
Otol00Ams
101 to 200 Amps�
g�s
Final
This request w�d
/8 monlhs f�om
Th�s request w�d
18 months,j.from
C� I �
L�ce�sed Electncal 1
Owner
r Address, 8oa or
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�wer SuoOl�er .
E lectr�ca I
�Aa i I�
AuMor�z
Air Conditioner
ther Dec� v
��39
Equ�pmenl Wired
Temporary Service
Lighting Fixtures
Electric Heatinq
Silo Unloader
Bulk Milk Tank
ther (Spec�fVl
Other
p Fse Fseders/Subtesders Fes Circuits
Oto30Am s �to30Am
31 to 100 Amps 31 to 100 Am
N Above 100—Am s Afwve 100_Am
Remote Control Circ. Partial!Other Fee
S ec�al I�spection 5�O � TOTAL FEE
/ / �(0�
Date �, the Elscirical
tnsDSCtor, hersby
certily thst the ebovs
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ire
ie �35� 2239
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tor When Ready
❑�es ❑No
i h�r�bv rsqusst insoect�on ot above
•Iectrieal work install�d at:
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ny Namel
pr pryne� Makinp I�sta�lat�onl
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,....., n..,..nr Mak�na InStallaU<
ontractor's Ucense No.
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