HomeMy WebLinkAboutElectrical Permit 11.280 L - (1-).4.--ii
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4 "nxEs(' CONTRACTOR /REGISTERED EMPLOYER REQUEST FOR
ELECTRICAL INSPECTION
Date Rough -In Inspection Required? o 0 Yes Inspection Other Than Rough -in: 0 Ready Now
Contractor /Employer Must Schedule II Rough -In Inspections Contractor /Employer Must Schedule All Final Inspe ions
�� `'�' Will
Schedule
Address of Inspection —S t Project Description: i
313 f r403 CAA Ck --- .e got
0 r Name �� j oft-T) 4 J a,� v.✓ „rezi ► 7 ?J rk y Pmt
Owner Phone q -r.Z 7 ct 1.r;' 7b /a1 1 F /, ef eh
Home: Cell: �j f23 �' �� � f
Contractor /Registered Emplooer Name Contractor /Registered Employer Mailing Address
Cont� 61 44 L. LL - L `q -7-3 e4;iNi J b - a, , p tv k.-
r /EmployerTelephone Number Contractor /Employer E -mail Address Electrical Utility .
Work: Cell:
C t actor /E ployer uthorize Signature Contractor License Number Job /Project Contact Person:
G ii 0 u 3 � Akin. p._ like
FEE CALCULATION
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Service /Power Supply 0 -400 ampere @ $35 , i.7 cJ Technology Systems Devices ( ) @ $ .75 Each
Service /Power Supply 401— 800 ampere @ $60 Separate Bonding Inspections for Swimming Pools and
Equipotential Planes ( ) @ $35 Each
Service /Power Supply Above 800 ampere @ $100 Center Pivot Irrigation Booms ( ) @ $35 Each
Plus ( ) Electrical Drive Units @ $5 Each
New /Extended Feeders /Circuits Up to 200 A (3) @$6 Each g Luminaire Retrofit Modifications ( ) @ $.25 Each
Feeders /Circuits Above 200A ( ) @ $15 Each Concrete - Encased Electrode Inspection ( ) @ $35 Each
Reconnected Feeders /Circuits Q( o @ $2 Each Y.3 ( Investigative Fee $70 Or The Total Inspection Fee,
SCa Whichever is Greater Up to $1,000
Manufactured Home Park Lot Supply ( ) @ $35 Each Special Inspection Fee ( ) Hours @ $80 Per Hour
Plus ( ) Miles @ The IRS Mileage Rate of ( ) ,
Recreational Vehicle Site Supply Equipment .
( ) Circuits Originating in the Equipment @ $6 Each Other 64 v [
P � l7( 1(
Street, Parking Lot, Lighting Standard ( ) @ $5 Each Over 600 Volts — Add the combined service /po!ver supply and
feeder /circuit fee to result in double the regular fee (does not
a..1 to electric si:n and outline li:htin:
Transformers Up to 10 kva ( ) @ $15 Each ( ) New Multi- Family Dwellings @ $70 Each
•
oe) State Surcharge of $5.00
( ) Additional Circuits Above the 20 Allowed 5/eV
Per unit @ $6 Each
Transformers Over 10 kva ( ) @ $30 Each TOTAL (the fee calculated above or $35 multiplied by the
number of re• uired ins .ectiontri.s, whichever is: eater
/4 d di. i+- ,`a>7a/ F fee eri �.) &Li 7 3 Receipt# Ce 1b.0- /0 f
Requests for Electrical Inspection (REI) with a fee of $250 or less expire 12 months from the filing date. The owner
must have the work completed within the 12 month period or submit another REI that includes the inspection fee for
the uncompleted work. Inspection fees do not carry over from one REI to another. A service charge of $28 will be
added for all dishonored checks.
I hereby certify that I inspected the electrical installation herein on the
dates stated:
Rough -In Inspection (s) Date Walt Lusian, Electrical Inspector
952.934.0229
Final Inspection Date
Order for Payment
Date Request for Inspection Serial Number Date Filed a. /2— // % / 0 J ) t / c —/ ""
Electrical Contractor /Installer License Number
Owner/Occupant County
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Job Address - Street , Cit ow ship
This Order for Payment is for additional fees associated with the above referenced Request for Electrical Inspection.
Fee Calculation /Explanation
ne2Vici "35. 02-
c,xed.),(7 ("Pqn o
� F CClNN GK-i_5(-V 2 = c96 ac,
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Return this Order for Payment with your check payable to theaMMIIIMMIONOMMIIIIMINO in the
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amount of $ 1 2 by (fourteen days from the date issued)
A service charge of $30 will be added for at dishonored checks.
Inspector ame and Number For Department Use Only
L Z./S//
Inspector Telephone Number
93 razz 9
Inspector E-mail Address/Website
Inspe ctor S nature
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