P - 75408REQUEST FOR�LECTRICAL INSPECTION
�° 8 2�� 2 5� � Minnesota Boa�d of tiec�iicity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0B00 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
Da�xibe -using the back oj the white copy if necressary - the work covered by this request: ,// _ �_ J��. ,�� �: y�'
PGRA L �P��'c.�-- ' ���`� d ��,
�� GENERAL FEES Outdaor Liahtina Standard an. $1
0 to 400
)MMUNICATION, REMOTE CQNTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
Cer�ter Pivot Irrigatlon Boom
Manufactured Home Park La
INSTALLATION
I�I ��I II I� ��i ��I II Ilf II �I II �I �� I�
18202515
Transformers up ta 10 KVA
Transfortners rner 10 KVA
Transformer / Power Sunol
Includ�s the Service andlor Power Supply up to 500 Ampe�, All
Circuits a� Tvro Inspection Trips Each DxreUing Unft (a� $80
�
total fee is
thet I Insoectad fhe elactriml insfallatlon
�
..Sp.
:CTED IF NOT COMPLETED WITHI 1�AONTHS
:-:rP, prFlt;E USE i71tiLY
o����� � 3 �
o�
�' Rough-in InspecNon RequiredT ❑Yes ❑ No Ins
��� I��� pecdon Other Than Rough-In: 0 Ready Now � WN Cell
You must cell the inspedor when readyl Date Ready.
I certity that I am the ❑ LICENSED COM'RACTQR ❑ COMPANY ❑ OWNER and hereby request ins�ction af the elechical work at