P - 79273REQUEST FOR ELECTRICAL INSPECTION
� � � 7 � � � ^ � � Minnesota Board of Electricity -
j 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
r (651) 642-0800 TTYIMRS 1-80D-627-3529 www.electricitys[ate.mn.us
fl NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
:(�EL Eh1ERGY SAVEt?'� 5��,`�T�H
GENERAL FEES Outdoor Liahtina Siandard fa� $1
0 to 4D0
GRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Center Pivot Irriqation Boom
Hour
F�
JD f0 �
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Cireuits and Two Inspection Trips Each Dwelling Unit @$8Q
Fee
(minimum total fee is $20) � $�0,50
iH15 AkEN FOR INSPECiOR I1SE pAY
I hereby certiry that I insD�d the electrical insialla6on described herein on the dates stated:
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Request Date: Rough-in Irtspection Required? U Yes L1Tb I InspeGion Other Than Rough-In: CJR�ady Now IJ WUI Call
�� f 2d f� You must call the inspacta when ready! Date Ready:
I certify lfiat I am the �.ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of ttie elecficai work at:
INSTRUC1fON8 ON BACK OF YELLOW COPY BOARD OF ELECTRICITY COPV EB-00007M14 6.1. 2002