P - 75677REQUEST FOR ELECTRICAL INSPECTION
2� 0 0�� 4 5 3� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TlY/MRS 1-800-627-3529 www.electriciry.state.mn.us
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I SERVICES / POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aoaaratus C� $.50
CeMer Pivot IrriaaUon Boom
1THIS INSTALLATION MAY BE ORDERED
I�11 u III u W II I�I II I�I II I�I u III II ul �� I�
20084539
Includes the Service andlor Power Supply up to 500 Am{�res, M
Circuits and Two Inspection Trips Each Dwelling Unit @$60
(minimum total fee is $20) �/ a
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�i�``�� = 6��
I hereby cerd(yt�hat 1 h�peded the etectrical Nsfa➢atlon des�aibed herein on tlre dates slaled:
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IF NOT COMPLETED WITHIN 12
FOR OF�ICE USE ONLY
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�� Rough-in Inspedfon Required? ❑ Yes ❑ No I�on Other Than Rough-In: ❑ Ready Now DUVm Ge0
�/� /�` You must ceU the inspectorwhen readyl Date Ready:
I csrtify that I am the � UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electritxl work at
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