P - 75980REQUEST FOR ELECTRICAL INSPECTION
J. _�/� �� Q 5 0 � Minnesota Board of Electricity
°'1' v 1821 University Avenue Suite S-128, Saint Paul, Minn�ta 55104
(651) 642-U800 TIYIMRS 1-SQO-627-3529 www.electricity.state.mn.vs
Descrit� -using tyhabac"k of the whfte copy if necessary - the work covered by this request:
C '_ s e �
, GENERAL FEES Outdoor Liahtina Sten (0�1$9
Above 200 Am ere $10
ALARM, CAMMUNICATION, REMOTE CONTROL
CIRCUffS, CIRCURS OF LESS THAN 50 VOLTS
Each Addfional Unit @
Cerder Pivot Irtiaation Boom
� Transformers wer 10 KVA $ 20
Transformer / Power Su for Si / Outline Li htl $5
ONE $ TN10 FAAAILY DWELLINGS, EACH UNR
Includ� the Service andlor Power Supply up to 500 Amperes, All
,� Ci�uits and Tvro Ir�spection Trips Each Dwelrmg Unft @$80
total fee is
I hereby cerlifyU�et I hispeded the elecLiral h�staVatlon d� herein on tlre detes s�ted:
aaicxw onh
�uw. usrecrior, � �^�
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THIS INSTALLATION MAY BE ORDERED DISCONNECTEQ IF NOT COMPLETED WITF
FqR pFFICE USE ONLY
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19418508 ��� �I I�
�� Rough-in Inspedion Required7 ❑Yes �to Inspedion Ofher Than Rough-In: �Aady Now �Wip CaA
� V l�! You muat ceA the Inspector when readyl Date Ready.
I csrtify tl�at I atn the �kICENSEQ CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection oFthB�lectrical work at
Job SRe Street Addr�s � Cit r�
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Townshtp — Sectl = Range � Ftre Na� Cawdy, �
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BOARDOFELECTRICIT/COW E&00001A-15 8.1.2004