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P - 78423. REQUEST FOR ELECTRICAL INSPECTION `� - 3 6 2�� J 0 �;° �- Minnesota Board of Electricity �e: 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651) 642-0800 TTY/MRS 1-500-627-3529 www. electrici ty. state. mn. us Identify the work covered by this request: ❑ NEW ❑ REMODEL ❑ ADDITION , �AEPAIR `� � J � GENERAL FEES SERVICES / POWER SUPPLIES 0 to 400 Am re �$25 401 to 600 Am re�$50 Above 800 Am re � $75 CIRCUITS / FEEDERS 0 to 200 Am re �$5 Above 200 Am re � $10 ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each S em Device or ratus �$.50 ADDITIONS TO THE GENERAL FEES MULTIFAMILY DWELLINGS PER UNI 3 to 12 Units �$50 Per UnA Each Additional Unit � $25 Li�hting Retrofit � $25 per Fixture Center Pivot Irrigation Boom � $4( Manufadured Home Park Lots � $ Recreational Vehide Park Si[es � iey bna Standard � Transformers u to 10 KVA �$10 Transformers over 10 KVA � $20 Transformer / Power Supply for Signs / Outline LigMing A$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service andlor Power Suppty up to 500 Amperes, All Circuits and Two In 'on Tri s Each Dwellin Unit �$8C Additional Inspection Trips � $20 Investiqative Fee total fee is I inspected tl�e electrical insfallation descr�bed he2in on Ihe dat� �d: 3p�ial Inspection �$.3t per Mile �-- �° Z"p ff� I THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS FOR OFFlCE USE ONLY �� lfllllllillllllllll111111111illlllliillilllllfllll �%� � �E 1 3 6 2 2 9 O 7�E F-� �,r!�� ( Re�Date: � I Rough-in InspecUOn Requiretl7 ❑ Yes ❑ No I Inspection O[her Than Rough-In: �J. Ready Now �J �tl Call I � �I You must call Uie inspector when ready! Date Ready: I certity that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricai arork at: