P - 77542j
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RE�UEST FOR ELECTRICAL INSPECTION � Q� A
O 7
"'X" Below Work Covered by This Request
Add Mp. Type o1 Su�ldinq Apo����c�s INirsd EquiDmsal Wir�d
Home Range Temporary Service
Duplex Water Heater Lightin Fixtures
Apt. Bullding Dryer Electric Heat�n
Commercial Bldg. furnace S�lo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm ther oeu v tne� IS�entvl
t r vec�(v t er Oiher
Compute lnspection Fee Below
a F�a S�rvic�Entranc�5ia• p Fsa Fasders�Subfesders � Fes Circuits
OtotUOAm l Oto30Ams Oto30Am
101 to 200 Amps 31 to 100 Amps 31 to 100 Am
Above 200 Am Above 100_Am s Above 100_Am s
Transformers Remote Control Circ. S'° Partial!Other Fee
Signs Special �nspection g�� �'+� TOTAL FEE
Remarks n
d !n-�+�� ^/%�'1out;Stv� ��+ ,�.. t ',�r
Rouyh-in Date �, �hs Electricsl
� Inspector, h�reby
urtily that the abovs
F'�a� - �^�P insp�ctioo has Dsen
� — — � •-L3 -O mede.
This repuest wid
18 n�onth5 f�om
This request w�d
18 month;,�.from � � � �
Request Oate Fire No. Rouph-�n InsDecuon
G— Z� Re u�red? O �Ready Now i Notity tnspec-
�yp � lor When Ready
❑ L�ce�sed Electr�cal Contractor i A�r�by ��pusst inspsct�o� ol �bovs
Owner •Isctricsl work �nstall�d at: �
Street Address, Box or Route No. C�tv
�! � 1 f v� (J GS/�Q. � � . � � �%L-[ c'� /'G � .
Occupant (PRINT► Pno��e No.
�`i � h' /t !� - c�r� • ._._
Power SupD��ar Address
Eiecu�ca� Contractor ICompanv Namsl Contractor's L�cense No.
Mailinp Address IContrsctor p Ownsr Makinp Insta�lauonl
AuMo�ized Sipnature (Contractor Owner Mak�np Installat�onl Phone Number
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