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HomeMy WebLinkAboutElectrical Permit 12. 419 �, ,�_.� vJll of 4[ z`Ert . CONT CTOR /REGISTERED EMPLOYER REQUEST FOR ELECTRICAL INSPECTION Date Rough -In Inspection Required? ,es Inspection Other Than Rough -in: 0 Ready Now `i 2- Contractor /Employer Must Schedule All Rough -In Inspections Contractor /Employer Must Schedule All Final Inspections ( / / 0CNill Schedule A dr of 1 pection —Street ,-- Project Description: / /N — C .c A vi+ IC.lt. Ow Name 0 ff■ c E A_Ent oOEL ttIAJAct RE Owner Phone Home: Cell: Contractor /Registered Employer Name Contractor /Registered Employer Mailing Address ig , 7 . 7 . < rA 5 u R u k . v v 1/4 . E t - E c T r 2 . t ‹- / 7 / 3 7 -- CREEK- k i c e PA S5 41 aJ Contractor /Employer Telephone Number Contractor /Employer E -mail Address Electrical Utility Work: Cell: 6a 645 3c 21 ractor /Employer Authorized Signature Contractor License Number Job /Project Contact Person: ALI-- EA 0 i703 33 eV.) 6 t2.FS 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 EquipotentialPlanes ( ) @ $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 ( ) @$6 Each Luminaire Retrofit Modifications ( ) @ $.25 Each / Feeders /Circuits Above 200A ( ) @ $15 Each Concrete- Encased Electrode Inspection ( ) @ $35 Each Reconnected Feeders /Circuits ( ) @ $2 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 ( ) Miles @ The IRS Mileage Rate of ( ) _ Recreational Vehicle Site Supply Equipment ( ) Circuits Originating in the Equipment @ $6 Each Other ( NCP S'-- 3 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 apply 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 trips, whichever is greater) / / O Pb Itl342. 2ct.Pr fl ` . (v�612 Receipt# (p 2 00 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 - Inspection (s) Date Walt Lusian, Electrical Inspector 952.934.0229 /' Final Inspection Date . Order for Payment Date Request for Inspection Serial Number Date Filed 2 /2 -0//9 ✓ / "/: / - Electrical Contractor /Installer :: License Number GSPEC UVar. c7g/ c� 200/ 703 Owner /Occupant County Job Address Street © Cit ownship This Order for Payment is for additional fees associated with the above referenced Request for Electrical Inspection. Fee Calculation/Explanation YlY �t�lT4 tcZv1 =D i Return this Order for Payment with your check payable to the in the amount of $ — by (fourteen days from the date issued) A service charge of $30 wit be added for all dishonored checks. Inspector Name and Number For Department Use Only Inspector Telephone Number Inspector E -mail AddresslWebsite Inspector Signature f 67