P - 77989RE�UEST FOR ELECTRICAL INSPECTION
'"X" Below Work Covered by �his Request
Add MeD• pe o/ Bwldinq ApO��ancsa W�rad
ome Ran9e
Duplex Water Heater
Apt. Bw Iding Dryer
Commercial Bldg. furnace
Industrial Bldg. Air Conditioner
ther pec� v
Farm
t � uec� v
Re lnspection Fee Below
Fee S�rvic�Entranc�Siz•
Otol00Am s
101 to 200 Amps
s
�
I Fina�
This request w�d
18 months hom
Fee Feeders�Su6tesdars p
Oto30Am s
31 to 100 Amps
Above 100_Am 5 `
Remote Control Circ.
S ecial Inspection S
�L07
Equipment Wired
Temporary Service
Lighting Fixtures
Electric Heat�nq
Silo Unloader
Bulk Milk Tank
ther tSoecifvl
D�+te
°ee Circul
0 to 30 Am
1 to 100 �
Above 100.
Partial �Oth
p� TOTAL FEE
I, ths Electrical
Inspector, hereby
certify thet ths ebove
insoactio� has bsen
mede.
iiiy�::�.�������i�a:��,� �� �r-..+i-s.���-�
,� +� ���
Th�s re0uest wid
18 mo�th5;.from �j�L ! ..�/ ! C? l � � � ! ���
''�� � r/
Request Oate Fire No. Rouyh-�n Inspecuon
J` ay Reoqu�red? ❑ �Ready Nuw [jW�ti Noufy Inspec-
fVes No tor When Ready
Licens EI ctr�cal Contractor 1 I��r�by request inspsctio� ot sbovs