P - 75399REQUEST FOR ELECTRICAL INSPECTION '
� _ � 2 0 � � � � � Minnesota Board of Electricity
�+m- �' 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.t�s
Descrfbe -using the back af the white ca y ff r�essaiy - the work covered by this requ�st:
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GENERAL FEES Outd�r Liahtina Standa na Q1
✓ICES / POWER
0 to 400 Amoere
CIRCURS OF LESS THAN 50 VOLTS
iystem Device or ApparaWs @ $.50
ADDITIONS TO THE GENERAL FEES
Unit @
CeMer Pivot
_ � THIS INSTALLATION MAY BE ORDERED U
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18202820
Traffic
20
ONE & TWO FAMILY DWELLINGS, EACH UNR
Includes the Service and/or Power Supply up to 500 Am�ras, All
Circuits and Two Inspection Trips Each DweAing Unit @$80
Additlonal Ins 'on Tri $20
Investl ative Fe�
Reins on Fee $20
TOTAL FEE �r
(minimum total fee is $20) �,��
nag a�a rroa wsae.,� us� ow.v
I hereby certlfy that I in�eded U�e electrlcal U�Ilatlon desmbed here(n on the dates atated:
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IF NOT COMPLETED WITHI
I�C'D �I°��`��`� 20 I
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Rough-in Inspecdon Required9 �� ❑ No Inspectlon Olher Than Rough-In: ❑ Ready Now 0 Wi0 Ca11�
�/� �/�� � You must call tlie inspador when readyl Date Ready.
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY�OWNER and heteby request inspection of the el�trical work at