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P - 78428eP �-3�47-327 ���` Identity the work covered by this request: ❑ NEW ,�EMODEL ❑ ADDITION ❑ REPAIR 0 to 400 Ampere � $ 401 to 800 Ampere (� Above 800 Amcere � 0 to 200 Amoere � REQUEST FOR ELECTRICAL INSPECTION Minnesota Board of Electricity 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us �• �� � �` //' , , _. _ � IMMUNICATION, REMOTE CONTROL, SIGNALING CIRCUITS OF LESS THAN 50 VOLTS ADDITIONS TO THE GENERAL FEES MULTIFAMILY DWELLINGS PER UNI 3 to 12 Units C� $50 Per Und Each Addibonal Unft � S25 Lighling Retrofit � $.25 per Fature CeMer Pivot Irriaation Boom � S4C Vehicle Park Sites � Transformers over 10 KVA � $20 Transformer / Power Supply for Signs / OuHine Ligh6ng �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service and/or Power Supply up to 500 Amperes, All Circuits and Two Insoection Trius Each Dwellina Unit �$8( �� Fee total fee is herein on tlie dates stated: �/� wh � �i �'�i�i �-�� al Inspection �$.31 per Mile � � �"���(`' S INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS I certi(y that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY�OWNER and hereby request inspection of the electrical work at