P - 75970REQUEST FOR ELECTRICAL INSPECTION
�.� 0 51 `�' �� 3 � Minnesota Board of Electricity �—/���
1821 University Avenue Suite 5-128, Saint Paul, Mi nesofa 04
(651) 642-0800 TTYlMRS 1-800-627-3529 www.edectricity.state.mn.us
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0 to 400
CIRCUITS OF LESS THAN 50 VOLTS
Pivot IrtigaUon Boom
1 I�I u I� II �U () ul II �I II � II III II III �� I�
�051,6233
Im�udes the Service aridlor Power Suppty up ro 500 Amperes, M
Ciraiits and Two Inspection Trips Each Dweuing Unit @$BO
total fee is
� ir�d Bre etechical ire�VaBon d�bed I�eteln on ure da�s �ed:
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�� I�� I� Rough-N Inspectlon Requtred7 ❑ Y� �No Inspection Other Than Rough-In: ❑ Ready Now � CaA
You must cell the inapector when readyl Date Ready.
I certify that i am the LICENSED COPITRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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or Owner Perfo ng Installadon) PI Provlde Two (2) Phorre Numbers I
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