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