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P - 80455, REQUEST FOR ELECTRICAL INSPECTION Minnesota Board of Electricity �-` 1-381-442 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651) 642-0800 TTY/MRS 1-500-627-3529 www. ele ctrici ty, s ta te, mn. us Identify the work covered by this request: O�tlEW ❑ REMODEL ❑ ADDITION ❑ REPAIR GENERAL FEES SERVICES I POWER SUPPLIES CIRCUITS / FEEDERS 0 to 200 Am ere �$5 Above 200 Am ere � $10 ALARM, COMMUNtCATION, REMOTE CONTROL, CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS Each S stem Device or A aratus (� $.50 ADDITIONS TO THE GENERAL f MULTIFAMILY DWELLINGS (PER UNI 3 to 12 Units @$50 Per Unit Each Additional Unit � $25 OTHER ADDITIONAL FEES li hiin Retrofit �$25 r Fixture Center Pivot Irri ation Boom �$40 Manufactured Hane Park Lots � $25 Recreational Vehicle Park Sites � $5 Se rate Bondin In �$20 r� S'al In ection �$30 r Fbur e Special InspecUon � $.31 oer Mile }SGEL ENERGY SAVER'� SWITCH Outdoor Lighting Standard C� $1 Traffic Sianal Standard � $5 Transformers u to 10 KVA �$10 Transformers over 10 KVA � $20 Transfortners / Power Supply for Signs / Outline Lighting �$! ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service and/or Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unit �$80 Additional Inspection Trips � $20 I hereby certiry that I ROUGH IN FINAL INSPECTION Fee � TOTAL FEE total fee is $20) DA7E DATE �4 _ FOR OFFlCE USE ONLY I IIIIII IIIII IIIII IIIII III� �� �I �� I�I ���' / "1 381 4421 '' �'�� Request Date: Rough-in Inspection Required? ❑ Yes ❑ Inspection Other Than Rough-in: eady Now ❑�II Call �g%��i You must call the inspector when ready! Date Ready: I certify that I am the `L) LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: