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P - 75307�� 443 Roaa ldorth Si Praul, NW 5515''.�-4342 ' Phoree: (659 ) '' TTYJMRS: ( �'297-4198 ,�,.e� ��.�,.� r....l.r�.wi�,.�/n....�. Date Ro�h-ln It�spedian Requtred7 �' �� t� 1 Co�d�rnn�r Must Sdn AddPess of If�eCGat1— Stfeet r S�Uc� �� __ + �,ii Yes W ��r �G��- ��- 3� ��'p �InU 8 200% #or Eiectricat Inspect�on �� D�Bd/ � OT1 f-'rii `tJ�et... Cis_ �+d Employer ittame Cot�trac6oriR�red Employer llAa�irtg Rcidr�s ��ee��•r.� 7_2�it7 f-1-��W� ��" ��i:� Fee Ca1Cl�la170i] sen+t�Po�rer supply o— 40o am�r+e �$� 00 Servic�/Power Suppfy 40'1— � ampere � $� Service/Povu�er Suppty 14bove 8� ampere @$10U New/Ext�ded FeederslCirt:u�s Up To 2a0 A{ �� )�� Each � FeedetsrCirauffs Above 2�Q �► ( ) @ $15 Each Recortnecbed Feeders/C€rc�s ( ) � $2 Each Manufadured Home Park Lot SuPA1�► ( )�$35 Ead� Recxea�l Vehir�e Sfte SuPR�Y �1�� ReadylJow VI�Il3cltedttle ' • � } � i �� f i'� :,' y�. _ � f,. 1 �'i Teclv�ology Sysbem !?evtces ( e Lumi�aire Re�roffi ModiRcat�ans ( a Concre�-Ea�cased Dedrode Inspedton ( Plus IRS ) @ 75�% Ea� �g Poo� and $35 Ead7 ).� $35 Each niF� $5 Eadt ) � 2b¢ Eacfi ) @ $35 Each ion Fee. . a � Per Hour tqe Ra� ot ( ) St�et, Parkfig Lot, L-i9hUn9 Sfian� ( )�$5 Each Overb'00 VaHs—aaa�aomem�a��y�a�e�atea� resuSln ��e�eguTartee (e�as ratapptytio e►ecbieat�n and ouffire �) Transflormers Up to 9 0 kwa ( )� S15 Ead� � )1Vevu Multi�amIIy �tn►e(Un,9s @$70 Each W�dt !lp To 2fl Feeders�Circufts TransFarmers Over 10 kva { )�$30 Eassh ( � Add�lo�i Cincu�s Above The 20 Apowed Per Unit O�ric Signs and OtdQne Lightfig To1�l (the fee calcuiated abaare or $35 muftip�ed ) Trar�stormersiPower Hes � $5 Eac� ��n�r o�f r,r+acN�� R�. /' � �� 1 R�qttests tor El�trical Irtspec8on {REt� wHh a T� aP $�0 or less �Ire 12 �aontl�s iroaa the flling date 7'i�e ca�rtrac�einployer must f�a� the �rk compleYed vvithh� ti�e 12 m� peri� ar �ano8�er l� thaR inctudes ti�a fi�onfeefor 9re nncompleted wwk irtspectlm� fees do � cazryov� `J -�� f Trom o� I�1 to ana�iter. D A servl� oPS� wAI b8 �d�d foi a9 �oita7� checks. 1 hereby ce�fHy that � 6�sPe�ed the eiart�al �on I�erein en the defes staYed: For Qepartment Use ONy Rough — In Irtspedion(s) -�✓ p� pale � g' .Z��•l--- �,�,• °' � " C�� Ffnal ir�s �� _ / i� This � made in differer�t farms, such as large pnt►t, Brailla or on a tape. To reqttest, cap 1-800�42�ib4 (DIA4DLn Voice or TDD (651) 29T-4198. Ro � ��, ° O° � ��. � � . °% . ! J O ' -p . � � . � L' c.+�5c�1 (�S i - 77 � �