P - 76247REQUEST FOR ELECTRICAL INSPECTION °��� �'
�� O"�'� � 9�� � IVlinnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, (&51) 642-0800 TTY/MRS 1-800-627-3529 www.electrrcrty.state.mn.us
Describe -using the back of th white wpy ff n��ssary - arork covered by this request:
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SUPPLIES
AboYB 80O
)MMUNICATION, REMOTE CONTROL, SIGNALING
CIRCURS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per UnR
Fee
20
Includa5 the Service and/or Power Suppty up to 500 Am�res, All
Circuits and Two Inspectlon Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Imesfiqative Fee
total fee is
Lighting Retrofit @$25 per Focture I hereby cerMy tt�at I inspeded tlre ete�iricai I�stauaficn descn'hed herein on the dams smted:
CeMer Pivot Irtigation Boom @$40 R01°"" 0A7E �7
Manufactured Home Park Lots $25 �• �� �� ` o
Recreational Vehicle Park Sftes $5 �''"` /� e �'�z` °AQ,7
Seoarate 8ondina Insoectian (rB Q20 l
LTHIS INSTALLATION MAY BE ORDERED DISGONNECTED IF NOT CUMPLETED WITHIN 1Z MONTHS 1
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I� i�C'D MAR 2 9 2007 ���� -���`�'
20079711 •
�� Rough-in Inspection Requfred9 ❑Yes ❑ No Inspecdon Other Than Rough-In: � Ready Naw � Will Cell
3 s v" �— �� You must call the inspector when readyl Date Ready.
I certify that I am the L'� uCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical work at
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Contrador / Company Name
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Mailing dresa (Contractor, Company or
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Authortr�d Signa� ( r or Owi
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ier Performing InslaOatlon) ��
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Pleasey Provide Two (2) Phor�re Njumbers Includtr�g Area Cade
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�se Number Master Electridan or Paw�er Limited Technidan
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Please Provide Two (2) Phorre Numbers Induding Area Code
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