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P - 79913, � REQUEST FOR ELECTRICAL INSPEGTION °°' �' Minnesota Board of Electricit " 1� Z 8 0,.17 g �'= 1821 University Avenue Suite S- 28, Saint Paul, Minnesota 55104 � _ (651) 642-0800 7TY/MRS 1-800-627-3529 www. electrici ty. state. mn. us Identity the work covered by this request: I� v'�tij �y��►t� EW ❑REMODEL ❑ADDITION ❑REPAIR GENERAL FEES �_ Outdoor LiohHna Standard �$ 0 to 400 Ampere � 401 to 800 Amoere 0 to 200 Amoere � CIRCUITS OF LESS THAN 50 VOLTS vstem Device or Apparatus � $.50 OTHER ADDITIONAL FEES Manufactured Home Park Lots � Recreationai Vehicle Park Sftes � Senarate Bondina Insoection � $: Su lemental Fee � $20 Transformers u to 10 KVA �$10 Transformers over 10 KVA � $2� Transformer / Power Su I for Si ns / Outline Li htin �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service and/or Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwellinq Unit (� $SC AddRionaf Ins eciion Tri s�$20 InvesUqative Fee Reinspection Fee � $20 TOTAI FEE ���. �� � . � (minimum total fee is $20'. FOR OFFICE USE ONIY � IIIIII IIIfI li�I11�NI ��II� ClIIf fIIII Ilill llil lll� � 1 Z Ei O 1 7 9 1�E that 0 -� � ,e rf .3503 '`�-S� I certify that I am the (�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at