P - 75795REQUEST FOR ELECTRICAL INSPECTION ��
1-� 5���� 3 �' Minnesota Board of Electricity
9821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
_ � , (651) 642-0800 TTY/MRS 1-800-627-3529 www.edecMicaty.state.mn.us
to
i THIS
)MMUNICATION, REMOTE CONTROt
CIRCUITS OF LESS THAN 50 VOLTS
ivstem Device or Aooaratus na $.50
� Retrofit @ $25 per Fature
Pivot Irripation Boom C� $40
�II II � II �I II �I II III � IIi il l� ll lli Q� l�
1955563�
ONE & 1W0 FAMILY DWELLINGS, EACH UNff
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two InspecUon Trips Each Dwe�ing Unit @$BD
Additional Ins on Tri $20
Inv� abve F�
Reins ction Fee @ $20
TOTALFEE
(minimum total fee is $20)
nusue�awanusrECra4 ow.
I hereby ceNfy tl�at I inspeded N�e electrical h�ellatlon d�crtbed herein on the datea st�ed:
= NOT CQMPLETED WITHIN 12 MONTI
Fc� oF� c�,�se arv��;
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° Rough-in Inspectlon Required7 ❑Yes�'IGo InspecUon OtherThan ouE
You must call the inspedor when ready! Date Ready:
I certify that I am th IGENSED C.ONTRACTOR � COMRANY ❑ OWNER and hereby request
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nse num�r master tiecmden or
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Now ❑IN'dl Call
re electrical work at