P - 75885REQUEST FOR ELECTRICAL INSPECTION
1-¢�1�� � o � 1. � Minnesota Board of Electricity �/�_ �(,��
1821 University Avenue Suite S-128, Pi£ Pa1, Mmnesota 5'S�04
�� � (651) 642-0800 TTY/MRS 1-800-627-3529 www.edechicity.state.mn.us
Dascnbe -using the badt of the wh' copy'rf necessa - the wrork covered by this request:
�� C�O rl �� -�?8�S
GENERAL FEES Outd�r Liahtina Stan $1
SERVICES / PC
oroaaoa
401 to B00
CIRCURS OF LESS THAN 50 VOLTS
ivstem Device or Aaaaratus (0'1$.50
Fndure
Cerder Pivot
S ecial Inspecdon a$.31 er hAite
THIS INSTALLATION MAY BE ORDEREI
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19130012
I Transfortner / Power Supply for Signs / Outime Lightlng @$5
ONE & TWO FAA4ILY DWELLINGS, EACH UNR
Includ� the Servi� and/or Powrer Supply up to 500 Amperes, All
Cirarits and Two Inspection Trips Each Dwre�ing Unit �$80
I
inimum total fee is $20) � ��
n9s ut�n wa usva.�on ug ow.r
I h�speaed the etectrical U�fellaUon desmbed frere6i on the datea s�ed:
�re
on�
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)T COMPLETED WITHIN 12 MONTHS.
fOR OFFICE USE OPriY
�j Rough-in Inspecdon Requfred? ❑ Yes No Inspe�lon Other Than Rough-In: 0 Ready Now Ca0
1, �`-�O� You must cell the Inspednr when readyl Date Ready.
I certify that I am the �LICEIVSED CONTRACTOR ❑ COMPANY � OWNER arid hereby request inspection of the electrical work at
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Township Section Renge Fire No. Counly
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��/�+Pant Neme r. . Pl�ae Provide Tww (21 Phorre Numbers Includina Area Code
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763-
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MSTRUCTIONS ON
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GonUac[or LI[�Itse Number Ma8Ler EleCtrician or Power Limttetl Technician
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Please Provide Two (2) Phone Numbers Indudh�g Area Code
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