P - 83784ri ey, inneso a
REQUEST FOR ELECTRICAL INSPECTION
""X'" Below Work Covered by This Request
Add Rep. pe oi Building Appliances Wired
Home Range
Duplex Water Neater
Apt. Building Dryer
Commercial Bldg. Furnace
Industrial Bidg. Air Co�ditioner
Farm Other peu v
t � uecify
ite lnspect�on Fee BeloK
Fee SsrvicsEntranceSizs
�tol00Am s
101 to 200 Amps
Above 200 Am :
Transformers
Signs
Fough-in
Final
This repuest vo�d [[[���
18 nionths from � -�j � [� N
V U
Th�s request void •
76 months from
Request Dat F�re
� -�c���'�
� Licensed Electncat Contrector
�Owner
Fee Feeders�Subfeaders N
Oto30Am s
31 to 100 Amps
Above 100 _ Am s
Remote Control Circ.
Speciai Inspection
���x�_t� ���_ s /
Date
lP.
1���6
Equipment Wired
Temporary Service
Lighting Fixtures
Electric Heatinq
Silo Unloader
Bulk Milk Tank
ther (Specifyl
Other
Fee Circuits
0 to 30 Amps
31 to 100 Am
Above 100_Am ;
artial�Other Fee
—�� TOTAL FEE
I, ths Electrical
. Inspector, hersby
certify that the above
�7 inspsction has baen
�7 �7 mads.
��76;� 1���6
��?� �� ��
Rouph-in Inspection
ReQuired? �Ready Now � Wi�l Noufy I�spec-
❑ Yes ❑ No tor When Ready
I heroby rsquest inspechon of above
electrical work installsd at: