HomeMy WebLinkAboutElectrical Permit 12. 251 it A
4 "A'N's'r CONTRACTOR /REGISTERED EMPLOYER REQUEST FOR
ELECTRICAL INSPECTION
Date Rough -In Inspection Required?
) Contractor /Employer Must Schedule AU Rou h -In Inspections s Insp r Oth Than Must Schedule 0 Ready Now
` � �' � I ` g Contractor /Employer Must Schedule All Final Inspections
Address of Inspection - Street / ®Will Schedule
3 (� tc P r at/r , 01. n A , Al 1, { Project Description:
Owne Nam 11,1-ii-h,
Owner Phone
Home: 47/ -4 ,' Iq . . .`0f i ; (`) Cell:
Contractor /Registered Employer Name
Contractor /Registered Employer Mailing Address
(lira-1M (t -
Contractor/Employer
Contractor /Employer Telephone Number E -mail Address Electrical Utility
Work: Cell:
r 3'goV 63b 6/R "n/ i # /ionic Pr i,-, h@i c ch , c4A6 M UE6
Co 4 tractor/Employer Authorized Signature Contractor License Number
3 '_. /�° fj / lob / Project Contact Person:
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
Pivot
Center Pivot
Service /Power Supply Above 800 ampere @ $100 E ui. I Planes @ $35 Each
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,
Manufactured Home Park Lot Supply Whichever is Greater Up to $1,000
PP 1 y ( ) @ $35 Each Special Inspection Fee
Recreational Vehicle Site Supply Equipment
( Hours Rate ( )
@ $80 Per Ho
Plus
PPY
( ) Miles @The IRS Mileage
( ) Circuits Originating in the Equipment @ $6 Each Other
���
Street, Parking Lot, Lighting Standard ( ) @ $5 Each V�
0 Vol -Ad to the comb j /,
feeder Over 60 /circui o t fee result in d ou ine ble the regu /power p l e a fee (does supply not ' ' 6 7
Transformers Up to 10 kva ( ) @ $15 Each apply to electric sign and outline lighting)
( ) New Multi- Family Dwellings @ $70 Each
(X) State Surcharge of $5.00
( ) Additional Circuits Above the 20 Allowed
Transformers Over 10 kva ( ) @ $30 Each Per unit @ $6 Each
TOTAL (the fee calculated above or $35 multiplied by the
number of required inspection trips, whichever is greater)
p dl7.4■ 35. - Za 721-
Receipt # C _( t, / ---
Requests for Electrical Inspection (REI) with a fee of $250 or less expire 12 months from the filing date. The owne
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
Final Inspection Date 952.934.0229
Order for Payment
Date Request, fo Inspection Seri 1 Number Date Filed .7
Electrical Contractor /Installer r ?
License Number
t : Ec E � /9 ssa 400 2
Owner /Occupant County
ANb '4 cc.,0
Job Address Street
C' Ci ownship
/ G'7 45s
This Order for Payment is for additional fees associated with the above referenced Request for Electrical Inspection.
Fee Calculatio xplanation
t = /A/s /aEcT /Qi / Fi /Gr 7 FIML
ddy�-
Return this Order for Payment with your check payable to the
in the
amount of $ 3.S by (fourteen days from the date issued)
A service charge of $30 will be added for at dishonored checks.
Inspector ame and umber
Z r L $ /,� For Department Use Only
Inspector Telephone Number
SZ P3fe a22
Inspector E -mail Addresslwebsite
Inspector nature