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P - 78623REQUEST FOR ELECTRICAL INSPECTION 1�2 8 2 2 8 9 Minnesota Board of Electriciry � � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651)642-0800 TTY/MRS 1-800-627-3529 www. electricity. state. mn. us Identify the work covered by this request: 7 c,YC� o -30 �p ❑ NEW ❑ REMODEL ADDITION ❑ REPAIF GENERAL FEES Outdoor Li htin Standard �$1 SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5 0 to 400 Am re �$25 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 for S� ns / Outline Li hTi �$5 0 to 200 Am re�$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Above 200 Am re �$10 Ihcludes the Service and�or Power Supply up to 500 Amperes, All ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80 CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins 'on Tri �$20 Each S em Device or tus �$.50 Investi tive Fee ADDITIONS TO THE GENERAL FEES Rein 'on Fee �$20 MULTIFAMILY DWELLINGS PER UNI TOTAL FEE 3 to �2 Units �$5o Per Unit (minimum total fee is $20 E2Ch AdddOnel Unit �$25 PoR INSPECTOR USE ONLV e�, � i�i OTHER ADDITIONAL FEES / Li hti Retrofit �$25 r FbRUre Center Pivot Irri tion Boom �$40 ManufaCturBd Home Pa�lt LOtS �$25 I hereby ce' that I inspected the electricel instapeBan described herein on the � stated: Recreatanal Vehide Park Sites �$5 101GH1N i�� Se rate Bondin In ion �$20 �Zj S ial Ins ion �$30 r Hour �.'"9"E�T'°" , °",� S epal In ' n�$.31 r Mile �'�i- �� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS FOR OFFICE USE ONLY i (��I�� 1���� I���I ��l�i ���i� ����� ��Il� ����� ���I ���I 2�-�, �E 1 c 8 Z 2 8 9 6�E ya.,s�% I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspec�on of the elechical work at: