P - 77995"X"' Below Work Covered by �his Request
Add Rep. Type ot Buildinq Apoliancss INirsd
F�a
ex
Commercial Bldg.
I ndustr i a l 81 dg.
Farm
t r uecify
>ecUon Fee Below
s..v�a. eoc..nc• s�:.
0 to 100 Amps
101 to 200 Amps
Above 200 A
Transformers
Signs
Cr-� r�-�v
Ro�on-��
Final
�_
Th�s request vo�d
18 nonths hom
Water Heater
Air Conditioner
the�T
�
�
w
�
�
-
�
�249
Equ�Dmsnt Wir�d
Temporary $ervice
Ughting Fixtures
Electric Heat�nq
Silo Unloader
Bulk Milk Tank
the� l$DeC��YI
Other
Fseders�Subfeeders +� Fee
0 to 30 Amps
31 to 100 Amps
Above 100_Am 5
Remote Control Circ.
Speciailnspectlon S S
�'_ �"Q.-
Date
D.� te
- /_ ,Z�- G
Circuits
0 to 30 Amo�
31 to 100 Arr
Above 100_
Partial!Other
TOTAL FEE
I, the Electrical
Inspector, hersby
certify thet the ebovs
inspection has bsen
msds.
,- ---� _�__�_��'-'_-.- - .r ��-.-..�..���� �37 �"zs-�"CS-tF�-i�.ss�ssssssri���s�a:s.1��.rr�.sr�����
7his request vO�d �� ��! ��
, e,��`h�.'`�, 2 2 4 9
Reque�� te Fire No. O h-��Inspec�t�� eady Nuw [j Wi�i No�ify tnspec-
2-��" •� Ves 1or When Ready
� ��censed Eiectncai Co�tractor i b���by nqusst inspsct�on ol above
❑ Owner ` •leclriul work inatalled et: �
Street Address, Boz or Route No. ��� City
(03 30 .� c �o h S �'.�� �
Occupant IPRINT) Pnone No.
/�%s-L �,�-�l c
POwer SuPD��lr Addres5
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EI tne.� pl Contractor ICortqanv Namel Contractor's License No.
t_�
Mailinp Address (Comractor o� Owner Makinp I�scallstion)
Authonied S�pnature (Contractor Owner Mak�np Installauonl Phone Num�bepr �
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