P - 77984REQUEST FOR ELECTRICAL INSPECTION
""X" Below Work Covered by �hrs Request
Add Mp. Typs ot BwldinQ ADD��aotea W�rsd
Home Ra�9e
Duplex Water Heater
ute
F�a
emarks
ouah-in
Apt. nwiaing
Commercial Bldg.
Industrfal Bldg.
Farm
t r uec�fv
S��vic� Entranc� Si:s
0 to 100 Amps
101 to 200 Amps
Above 200 Amo;
Final
This reduest w�d
18 no�ths hom
Air Cond�tioner
ther c� v
t e r �..
�;.:
Fae Fesde�s�Subfesders A
Oto30Am s
31 to 100 Amps
Above 100—Am s
Remote Control Circ.
Specialinspection 5
2273
Equipmsnt Wired
Temporary Service
Lighting Fixtures
Efectric Heating
$ilo Unloader
Bulk Milk Tank
ther (Soecify)
Fee Circuits
0 to 30 Am �
31 to 100 An
Above 100_
Partia� �Other
� � TOTAL FEE
--�- 1, the Electiical
Inspector, h�reby
certify that the ebovs
�^�P insp�ction has baen
� $ ^� m�de.
�
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Th�s repuest w�d ����� ��0�
18 months�•from ''}�� ,/` Q� a� O
�� `� " 2273
Request Date F�re No. Rouph-m inspection
Requ�red? �Reatly Now [� W�it Noufy Inspec-
❑Yes �No �or When Ready
licensed lect cal ConVector � I b�r�by r�qusst inspsct�on ot eDovs
❑ �^e� •lect�ic�l work �nstall�d at: �