P - 75457REQUEST FOR ELECTRICAL INSPECTION
������ 4 3 0� Minnesota Board of Electriciry
1821 University Avenue Sufte S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-3529 www.electricity.state.mn.
Describe -using the 6ack of the white copy ff necess/ary� - the work covered by this request:
� e ei /� �/d� � �OPsJ �rB' t o. �� �S' — dt�. s— t��P'lP�, �,.. O �T���'7� .�v'UiC�
0 to 400
Includ�s the Service and/or Powrer Supply up to 500 Amperes, A�
Circuits and Two Inspection Trips Each Dweliing Unit @$80
,UITS, CIRCUITS OF LESS THAN 50 VOLTS
Eac� Svstem Deviw or Aouaratus a�. $.50
TOTAL FEE I L(d/
total f� is $201 �
S' /v. 3
I herebv certHv that I i�eded the elechical 6iatellatlon d�albed herein on the dates sf�ed: I
Center Pivot Irrination B�m
� THIS INSTALLATION MAY BE ORDERED DISCONNECTED1F NOT COMPLETED WRHI 1�M_ONTHS
l.,� . FOR 0(=�ICE USE QhlLY � t 2/�
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18204305 �,�F���� ���
Rough-In Inspectlon Requfred7 ❑Yes ❑ No Inspedlon Other Than Rough-In: ❑ Ready Naw ❑ WIII Call
9��p /�ji You must caU the inspedor when readyt Date Ready:
I cerfify that I am the � LICENSED CONTRACTOR ❑ COMPANY �OWMIER and hereby request inspection of the electrical work at
Job SRe Street Addr�s City ��
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Master Electridan or
Ltcense Number
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