HomeMy WebLinkAboutElectrical Perit 11.066 0-64i4-
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„A„ � CONTRACTOR /REGISTERED EMPLOYER R FT R
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ELECTRICAL INSPECTION
Date Rough -In Inspection Required? 0 Yes Inspection Other Than Rough -in: 0 Ready Now
Cl / 5I2011 Contractor /Employer Must Schedule All Rough -In Inspections Contractor /Employer Must Schedule All Final Inspections
XWill Schedule
Address of Inspection- Street Project Description:
5810 I5Q•+I. 5- .SE
Owner Name i dekt8 gpriaee,
P .1 , ¶ L; g�. �ovir c fir►,, � r , r
Owner Phone
Home: 4oi2-gg1-filly Cell: 0I2 "tea 6$77
Contractor /Registered Employer Name Contractor/Re istered Emplo er Mailing Address
last 5- C?skAve
Qu al ►� � I er■ c , c • IC) 1eiOcv ta, mr l ‘B5CCOO
Contractor /Employer Telephone Number Contractor /Employer E -mail Address Electrical Utility
Work: Cell:
S tor, @ct�t y•e1 com rrV Sal - 4 51 - SG l b � -y5 6-I
&i7 7[i$ ec
ontractor /E yer Authorized Signature Contractor License Number Job /Project Contact Person:
CA 014 Joel - ,per e'
FEE CALCULATION
Service /Power Supply 0 -400 ampere @ $35 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
Plus ( ) Electrical Drive Units @ $5 Each
New /Extended Feeders /Circuits Up to 200 A (!4 @$6 Each Luminaire Retrofit Modifications ( ) @ $.25 Each
2"
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 ( ) W �
Recreational Vehicle Site Supply Equipment
( ) Circuits Originating in the Equipment @ $6 Each Other ,-(/l/
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
(1) State Surcharge of $5.00
( ) Additional Circuits Above the 20 Allowed 5
Per unit @ $6 Each
Transformers Over 10 kva ( ) @ $30 Each TOTAL (the fee calculated above or $35 multiplied by the �_/ OC7
number of required inspection trips, whichever is greater) -
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 fot
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
.*;. e•)
Order for Payment
Date Request for Inspection Serial Number Date File
Electrical Contractor /Installer or ' t.e4L License Number
41 (SAL/ TLC _-L G T / iC c ,)47 o v / ,e t- 45( -5
Owner/Occupant County
.l N PROVc ET eel , -J'o: 4 1 ,� i7—
Job Address = Street 7 /4 f�Ci ownship
5Y/0 /0 67•
_ o L
This Order for Payment is for additional fees associated with the above referenced Request for Electrical Inspection.
Fee Calculation /Explanation
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Return this Order for Payment with your check payable to the in the
amount of $ JJ by (fourteen days from the date issued)
A service charge of S30 will be added for all dishonored checks.
Inspegtor Name and Number For Department Use Only
C /y�-r C_US / N
Inspector Telephone Number
95z 0
Inspector E -mail Address/website 1
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