P - 76303r REQUEST FOR ELECTRICAL INSPECTION
� ��� � �q, � � Minnesota Board of Electricity
��� ��� 1821 University Avenue Suite 5=128, Saint Paul, Minnesota 55104
_ (651) 642-0800 TTY/AARS 1-800-627-3529 www.electricity.state.mn.zrs
D�aibe -using the back of the white copy iF necessary - the vvork covered by this,�r�u�t:
�,�.L. i�� �• _ �c.c v�a % _C � _ `�°i"�i�`°%�C�J
401 to 800
Above 800
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Apparaws Q$.50
ADDITIONS TO THE GENERAL I
Center Pivot Irriaation Boom
20
Includes the Service and/or Power Suppty up to 500 Amperes, AII
Circuits and Tsvo Inspection Trips Each Dwelling Unit @$80
Addfional Inspection Trips (a� $20
Irnestiqative Fee
BE ORDERED DISCONNECTED IF
�II II II� II W II III II I�� II �I �(II I� IU � IU (�
'1473434
total fee is $20) � �o �'
I inspected fhe electriral instaVation desralhed herem on fhe daf� sMeOed:
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FiiP. CiFP!��L U5E �LY
,�,6(��j Q/o��
��p ,�UN 18 2007
�� Rough-in Inspectlon Required? ❑Yes �o Inspedion Other Than Rough-In: � Ready Now�(Wi0 Call
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You must call the inspedor when readyl Date Ready.
I certify that I am the �JCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Addresg � CitY
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Master Electrldan or Power
License Number
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