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P - 79847� T ` REQUEST FOR ELECTRICAL INSPECTION Minnesota Board of Electricity � i 2� 3� O 6 5 � n 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 ' (651) 642-OS00 TTY/MRS 1-800-6273529 www.electricity.state.mn.us '� ' IdentiTy the work cavered by this request: ❑ NEW REMODEL ❑ADDITION ❑ REPAIR T"1 �11✓' `''�" ��� ' `v"'� � GENERAL FEES Outdoor Liahtina Standard (� $1 401 to 800 Am ere (� $50 Above 800 Am ere � $75 �UITS / FEEDERS 0 to 200 Am ere �$5 Above 200 Am ere (� $10 RM, COMMUNICATION, REMOTE CONTROL, SIGNALING �UITS, CIRCUITS OF LESS THAN 50 VOLTS Each S stem Device or A aratus �$.50 ADDITIONS TO THE GENERAL FEES .TIFAMILY DWELLINGS PER UNI 3 to 12 Units �$50 Per Unit Each Additional Unit � $25 ' OTHER ADDITIONAL FEES Li htin Retrofit �$25 r Fixture Cemer Pivot Irri ation Boom �$40 Manufactured Home Park Lots �$25 I Recrea6onal Vehicle Park 5ites � $5 ` S arate Bondin Ins �on � $20 Soeciat Insoection � $30 uer Hour _ , ♦ ' Su lemental Fee � $20 Transformers u to 10 KVA �$10 Transformers over 10 KVA � $20 Transformer / Power Su for Si ns / Outline Li htin �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT Includes the Service andlor Power Supply up to 500 Amperes, All Circui4s and Two Ins ection Trips Each Dwellin Unit �$8C Additional Ins ection Tri s�$20 Investi ative Fee Reinsoection Fee � 820 IF � total fee is c, ��LY-�`f I 3 MONTHS FOR OFFICE USE ONLY � 1����� �«�l 1���«���� il��� i���11»il l»�� �1�1 ���1 �,��'/�, 3E 1� O 3 D 6 5 6�E � '�C/'s� Request ate: Rough-in Inspection Fiequired? ❑ Yes ❑ No Inspection Other Than Rough-tn: ❑ Ready Now � WA1 Cell ?j Z, You must call the inspector when readyl Date Ready: I certify that I am the ❑ LICENSED CANTAACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the efectrical wak at