P - 75866� REQI#EST E�9R ELECTRICAL INSPECTION
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Identlfy the work covered by this requ�t
❑NEW �BEMODEL ❑ADDITION �REPAIR
GENERAL FEES Outdoor U' Standard �$1
SERVICES / POWER SUPPLIES Tra(fic Si Sffitderd �$5
b to 4D0 re��t5 lememal Fee �$ZO
401 to 8� Am re �$50 Transtormera to 10 KVA �$10 '
pyove g00 pm �$75 Trensfomrers over 10 KVA C� $20
CIRCUITS / FEEDERS Trar�sfomter / Pmwer S 1 for Si / OuUine Li �$5
0 to 200 Am re�$5 ONE & NJO FAMILY DWEWNGS, EACH UNR
Above 200 Am re�$10 Includes the Service and/or Power SuPP�Y �P to 500 Am�r�� M
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Ciraiits emi Two Ir�s on Trips Each DweIG Unit ��0
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addib'orrel I� ' n T �$20
Each m Device or A �$.50 Im��tl ' e Fee
ADDITIONS TO THE GENERAL FEES Reins n Fee �$20
MULTIFAMILY DWEWNGS PER UN TOTAL FEE �^
3 to 12 Utdts �$50 Per Un(t (minimum tatal fee is $20) �J
FeCh Adt�tiol181 Unit �$25 wx ws�croa usE aur
OTHER ADDffIONAL FEES
Li htin Retrofit �$25 r Fbchue
CeMer Pivot Irti n Boom �$40
Manutactured Home Park Lots C� $25 I hereby certify thet I electrical ins�ua8on desa�'bm1 hazein on the dams ate�:
Recteador�al Vehide Pazk S(tes �$5 fl0�' °Y % °A'E
Se Bo I on �$'LO c��— �
S�ial InsoecHon � P30 oer Hour `�"'' �"�' . ��"� I
THIS INSTALLATION AAAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITIiIN 7SIVlONT1is
FOH OFFlCE USE ONLY � �
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pequest • Rough-in Inapectlon Requlred? Yes ❑ No IrepecUon Other Than Flough-In: ❑ Ready Now Cell
`O 1% o� You must call fhe irispector when reedyl Date Ready:
I certHy that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �OWNER end hereby request inspection of the elscMcal work at
Job Address (Street, Box, or Route No.) ' City' � aP �e
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Sedton T Ip Renge Flre No. Co�mly
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Powar Suppller � �� Address�1 S � � ^ \ � �
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Dectiical Contrac�r / Company � Q g_'` CoMrac[or Llcer�se Nwnber Master Ucer�se Number
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Mafling Address (Contrector, Co or Owner Perfortning Installadon)
Authorized SlgnaWre ( r erforming InsteDatton) G� � s� / v'.' ��«� �
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E8-00001A-13 7/12000 BOARO OF ELECTHICifY COPY W97AUCTICPIS ON BACK OF YELLOW COPY