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�
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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
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I certify that I am the (�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at