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HomeMy WebLinkAboutElectrical Permit 12. 459 O t pR1O4 PE'R1111Pr w 1 '" 6°T1 4twasc CONTRACTOR /REGISTERED EMPLOYER REQUEST FOR ELECTRICAL INSPECTION Date Rough -In Inspection Required? Inspection Other Than Rough -in: 0 Ready Now / (I -f � Contractor /Employer Must Schedule All Rough -1n insp Ions Contractor /Employer Must Schedule All Final Ins ions ( c7t I Schedule Address of inspection - Street Project Description: � �5 f6 R 3/ y �3 ���� Owner Namyy,, 6re her e Owner Phone iiernetnizi 60 , g- / /,� 5— 6 Contractor /Registered Employer Name Contractor /Registered Employer Mailing Address �t (KS t;f(e E le - hoc_ ) �-3q-o � �� 4i 5 73 aks lie_ rylio 3c> ( e-, Contractor /Employer Telephone Number -/---- Contractor /Employer E -mall Address Electrical Utility Work: Cell: 6, /a - mod` - q5, 5 -`70/0 Z_ 7312 - rse. liwy'rsir.(Ieeiect iqG . arm Contractor/Employer �t� , f��i Authorized Signature Contractor License Number Job /Project Contact Person: ` 7/ 0 t �A o 3T "7 — 4P / � - a 3 FEE CALCULATION Service /Power Supply 0 -400 ampere @ $35 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 C 00 Plus ( ) Electrical Drive Units @ $5 Each New /Extended Feeders /Circuits Up to 200 A ( ) @$6 Each Luminaire Retrofit Modifications ( ) @ $.25 Each Feeders /Circuits Above 200A ( ) @ $15 Each Concrete - Encased Electrode Inspection ( ) @ $35 Each Reconnected Feeders /Circuits ( ) @ S2 Each Investigative Fee $70 Or The Total Inspection Fee, Whichever is Greater Up to $1,000 Manufactured Home Park Lot Supply ( ) @ $35 Each Special Inspection Fee ( ) Hours @ $80 Per Hour Plus f ) Miles @ The IRS Mileage Rate of r ) Recreational Vehicle Site Supply Equipment ( ) Circuits Originating in the Equipment @ $6 Each Other q �> , r � ,� / `E 2 43/3 3 / 3 1 55 Street, Parking Lot, Lighting Standard ( ) @ $5 Each Over 600 Volts - Add the combined service /power supply and feeder /circuit fee to result in double the regular fee (does not appt to electric sign and outline lighting) Transformers Up to 10 kva ( ) @ $15 Each ( ) New Multi- Family Dwellings @ $70 Each ( ) State Surcharge of $5.00 ( ) Additional Circuits Above the 20 Allowed Per unit @ $6 Each Transformers Over 10 kva ( ) @ $30 Each TOTAL (the fee calculated above or $35 multiplied by the number of required inspection tries, whichever is greater) ?(2(P / /'.�crc � /C - z/ �3 /ice-- -- 6 y4 / /. " Receipt # 776 7 Requests for Electrical Inspection (REI) with a fee of $250 or less expire 12 months from the filing date. The owner( b h p must have the work completed within the 12 month period or submit another REI that includes the inspection fee for 5 the uncompleted work. Inspection fees do not carry over from one REI to another. A service charge of $28 will be f ( added for all dishonored checks.„>Y,d'V I hereby certify that 1 inspected the electrical installation herein on the dates stated: Rough -In Inspection (s) Date Walt Lusian, Electrical Inspector 952.934.0229 Final Inspection Date • lel l name, must 00344 L"'“'' "'Zr; v-v.wr a:=, + TeL (952) 934 -0229 fho . -Fri. Order for Payment Date Request for Inspection Serial Number Date Filed 2 . 0 - 4 r„ l -2_ oV3T ((-- 27-/2- Electrical Contractorlirrstalier License Number ORu5_ / 2Z ,' -- ,9 coo l Owner / Occupant County e '' ; )c)W9 -bS 51 4, / f 6 c_oir Job Address - Street Ci ownship /6 8 (3 " P, oiee LI 4 This Order for Payment is for additional fees associated with the above referenced Request for Electrical Inspection. Fee Calculation/Explanation /c oo iy. ,Q $T'r E.- too. 00 tow 5— ate ft0 F sa S@('' 7 0P '2 -- o 6, 349 C ©u t Rev is @ 77L1 , oV (Z pa..E., Lwrrs q J v o C 0 6 * iAL F 1 0 ). D4 /40i011 r''Cl '2 '64MH Du-- ' / 5,._ V 1 Y'''..f.' 1N kfr)('JA eiL—. de 7 1 tA l ' ()APciti Te9 0 A -V�� Cc Return this Order for Payment with your check payable to the in the 00 amount of $ (5 by (fourteen days from the date issued) A service charge of S30 will be added for all dishonored checks. Inspector Name and Number For Department Use Only Inspector Telephone Number Inspector =mail Addres bsite Inspector Signature