P - 77981•auv�.a �� vn GLGV 1�11 VAL ���.7r GV 1 �V��
"'X" Below Work Covered by This Request
Add ReD- Type ot Buildinq ApD��ancsa Ylirsd
Home Range
Duplex Water Heater
Apt. Bwlding Dryer
Commercial Bldg. furnace
Industrial Bldg. Air Conditioner
Farm ther oec� v
t r pecify
ute lnspection Fee Below
Fee S�rvic�Entranc�Siz•
� t0 1OO Artl S
101 to 200 Amos
� � Jigns
Remarks
1
Rouph-in
Final
This reQuest w�d
18 month5 I�om
Fsa feeders�Subtesders !
Oto30Am s
1 to 100 Amps
A bove 100 _ Am s
Remote Control Circ.
Spec�allnspection 5
�267
Epu�pmsnt Wired
Tempprary $grvice
Lighting fixtures
Electric Heat�nq
Silo Unloader
Bulk Milk Tank
the� (SDec�fvl
Other
Pee Circu
� to 30 Am
31 to 100 �
Above 100.
Partial!Oth
)_ TOTAL FEE
' I, ths Electricsl
Inspsctor, hersby
csrtity thst the ebovs
�'��P/ inspection has bsen
:ZC:� �� rreds.
- w�..ss s�� a a: �: s s a.s� s ae a s: sac�arwr �
a �'�. � a
Th�s rEquest vo�d (J ��„/
18 month�.from %� �%` C.�Q/�C J� r�V 2 2 6 7da�
�; �� �
Request Date • Flre No. Rouph-�n Inspection
L ReQu�red? �Reatly Now [j W�n Not�fy I�spec-
� ❑�es �No tor When Ready
Licensed Electr�c Contrqctor O['1 A 1 ti�r�by r�qusst inspsction of sbove
❑ Owner ll �C� slecVical work �nsfalNd at: �