P - 77211, REQUEST FOR ELECTRICAL INSPECTION
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Identity the work covered by this request: �. �/1
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❑ NEW ❑ REMODEL ADDITION ❑ REPAIR %',` (/U -�'� D �G"/� ry! CrQ' J�
GENERAL FEES Outdoor Li hGn Standard �$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 U Su lemental Fee �$20
401 to 800 Am re �$50 Transfortners u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / OuHine Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$t0 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unft �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional In ion Tri �$20
Each S stem Device or aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee (� $20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE �
3 to �2 Units �$5o Per Unit (minimum total fee is $20)
Each Additional UnR � $25 � ���T�+� �Y
OTHER ADDITIONAL FEES ` � �
' htin Retrofit � $25 er Fixture y�
Center Pivot Irri ation Boom �$40 �cs•.S�l/
ManUfaCtured HORie Pa�l( LotS �$25 I hereby ceAity that I inspecied the electrical insta�described �n �e date�sta3led;
Recreational Vehide Park Sites �$5 /01GN "' r�..� , o��
Se arate Bondin Ins ection �$20 � –�_–�1� �"` G—�--c 3
S ial Ins ion �$30 r Hour FlN4 �NSPE�nON o�,�
S ' In 'on � $.31 r Mile „C,s � /�t� �-- l +� � Z_ c,
_ THIS JNSTALLATION MAY BE ORDERED DISCONNECTED IF NOT OMPLETED WITHIN 1 MONT S
FOR OFFICE USE ONLY
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Request,fla �� Rough-in Inspection Required4 Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑ wll Cail
� You must call the inspeclor when ready! Date Ready:
I ceRify that I am the�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection oi the electricai work at:
Job Address (Street, Box, or Route No.) City ,p Zip Code
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Section Township nge Fir No. CouMy
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�u�"� Phone
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Power u plier Address � G `�� t 1� .._ l ���
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Electrical Contractor / Campany Name Contractor �
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Mailing Address (Contractor, Company� yo�r�Owner Performing Installation)
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Authorized ature (Contractor, Company or Owner Performing Installation)
E&00001A- 3 7/1/2000 BOAFiD OF ELECTAICfTY
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as[er License Number
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INSTRUCTIONS ON BACK OF YELL COPY