P - 76114REQUEST FOR ELECTRICAL INSPECTIOIV �j
1� 9 7 3�� 3 9� Minnesota�oard of Electricity
1821 University Avenue Suite 5-128, Saint Paul, M' ta /�� �
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(651) 642-0800 TTY/MRS 1-500-627-3529 le .s te.mn.
Describe -usU�g the bac ��the white copy'rf necessary - th work covered by this requ�st:
� Yt.�-� "e�� 1�3 �, �.�a� �r� i V�� ra�. ca �n c�� � 1� (10�- oc �i
suaPUes
st�d�rd
w Atn re a� 55 ONE & Nd0 FAMILY DWEWNGS, EACH UNR
200 Am re$10 Include.s the Service and/or Pwver Supply up to 500 Amperes, All
IMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspec�on Trips Each DweAing Und @$BO
CIRCUITS OF LESS TFIAN 50 VOLTS Addfional Ins on Tri $20
i m Device or Apparatus @$.50 Imesti ative Fee
ADDRIONS TO THE GENERAL FEES Reins 'on Fee $20
ILY DWEWNGS ER UN TOTAL FEE s� �
untts @$50 Per untt (minimum total fee is $20 L
Idd'ItIOI181 U�d @$25 nusn�aFm ws+ECroa ug anr
orH�aoomow� F�s
RetrOfit @$25 pBr Fu�due I hereby certlfy that I I�pected the electr(cal instellatlnn descnbed herein on fhe dat� stated:
Pivot Irriaation Boom id $�10 �"�' ��
S Insp�on $.31 per Mile
THIS INSTALLATION MAY BE ORDERE
IIUI�uII������UWU�Iu��� I�
19735398
�NNEGTED IF NOT COMPLETED WITHIN 92 MONTMS
FG� r_�FicE uSE C�vr
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"°`°. Rough-in Inspectlon Requtredl ❑Yes �No Irispection Otlier Than Rough-In: ❑ Ready Now�W10 Ce�
� t�� �� You must call the inspector when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ CQMPANY ❑ OUVNER and hereby request inspecti�n of #he electrical work at
�o` �1�qd�ic��d� c� ri cl «.
TownshiP S�tlon Range Flre No. County
�d, � o ��
Owner/Oa�pant Name Piease Provide Two (2) Phone Numbers Induding Area Code
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�nse rvumber Master Elechidan or Power
2 Z � � License Number
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