P - 75229REQUEST FOR ELECTRICAL INSPECTION ����
�'�1��� � 314 � Minnesota Board of Electricity a;
1821 University Avenue Suite S-128, Sainf Paul, Minnesota 55104
����y�'� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.
Describa -using the bac cTof the whfte copy if necessary - the work covered by this request:
0 to
CIRCUITS OF LESS THAN 50 VOLTS
iystem Dewce or APparatus @ $.50
ADDITIONS TO THE GENERAL'
Center Pivot Irtiaation Boom
�LLATION MAY BE ORDERED_
I�II ��I � dl Il ill II I� Ii �l II �I II III �� I�
21473145
— 1 I J' I
Outdoor Lighting Stand
Traffic Sianal Standard
In%udes ihe Service and/or Power Supply up to 500 Amperes, A�
Circuits and Two Inspection Trips Each Dwellir�g Unit @$80
(minimum total fee is $20) � o(Cr
� ���� ������a�.
NFO-
I hereby certihi thet I inspected tlre electricai inetaVatlon desaibed
I IF NOT COMIPLETED WITHIN 12 I
REC'D J t�tF,�.��s����001
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�� Rough-In Inspectlon Requlred? ❑Yea �No I�pec:tion Other Than Rough-In: � Ready Now WAI Call
���(J� You must cell the inspector when ready! Date Ready.
I ceitify that I am the�[ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER arid hereby request inspection of the electrical o+rotk at
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A9aster Electridan or P
Li�nse Number
ao (2) Phorte Numbers I
7-�20 )