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Identify the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR
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.electricity.state.mn.us " '
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re�$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus �$.50
ADDITIONS TO THE GENERAI FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Lighting Retrofit � $25 per Fixture
Center Pivot Irrigation Boom � $4(
Manufactured Home Park Lots � $
Recreational Vehicle Park SRes �
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Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA (� $10
Transformers over 10 KVA � $20
Transfortner / Power Su I for Si ns / Outiine Li htin f� $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additional Insoection TriDS (� $20
d Ins ion �$.31 r M�e
5 INSTALLATION MAY BE ORDERED DISCONNECTED IF
FOR OFFICE USE ONLY
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total fee is $20) n0�
ion �ksaib � erein o B ates stated:
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D WITHIN 18 MONTHS
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I certify that i am the �UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
E&00001A•13 7/1/2000 BOARD OF ELECTxN:rir cc7r7 mainw:�i�na am ow�n vr .�..�........r.