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P - 816821-0?6-461 ;� e ��;. �s IdentiTy the work covered by this request: ❑ NEW ❑ REMODEL pADDiTION ❑ REPAIR GENERAL FEES SERVICES / POWER SUPPLIES 0 to 400 Am ere �$25 401 to 800 Amoere � $50 0 to 200 Ampere � Above 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. e lectricity. sta te. mn. us �UITS, CIRCUITS OF LESS THAN 50 VOLTS Each System Device or Apparatus (� $.50 ADDITIONS TO THE GENERAL FEES .TIFAMILY DWELLINGS (PER UNI� 3 to 12 Units �$50 Per Unit OTHER ADDITIONAL FEES Li htin Retrom �$25 er Fixture Center Pivot Irri ation Boom �$40 Manufacfured Home Park Lots �$25 i Recreational Vehicle Park Sites � $5 ` rate Bondin Ins ection � $20 S ial Ins ection �$30 r Hour ' Soecial Insoection � $.31 oer Mile Outdoor Liahtin4 Standard � Transformers up to 10 KVA �$10 Transformers over 10 KVA � $20 vrv� a i vv� rnmiu VYYCLLIIYVJ� CX1dl VIVI I �' Includes the Service andlor Power Supply up to 500 Amperes, All Circufts and Two Inspection Trips Each Dwelling Unit �$8( Additional In ion Tri s�$20 Investi ative Fee Reins ection Fee � $20 TOTAL FEE (minimum total fee is $20 I inspected the electricel insialla6an descxibed herein on the date,s stated: THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS r�a � use o�v � I IIIIII IIIII Illf! {IIN IIIII II�I Illlf 1111 IIII ,� � 1 Ll 7 6 4 6 1 1 3E Reque ate: � Rough-in Inspection Required? �,Yes ❑ No Inspeclion Other Than Rough-In: ady Now � Wil� Cafl / , You must call the inspeMOr when ready! Date Ready: I certity that I am the �jCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at;