P - 76257, pREQ�JEST FOR ELECTRICAL INSPECTION
2°� o��� 01 �� , Minnesota Board of Electricity
1821 University Avenue Suite &128, Saint Paul, Minnesota 55104
��.�' • K651)642-0800TTY/MRS1-800-627-3529www.electricity.state.mn.us
D�cdbe -using the of the white copy if nec�sary - the work cover� by this r�u�t:
A� �� �.� � �°�r . ,� -+,rO ��, .�� t _; A a� � 1.� ,�CI,. � �.�M
�s
401 to 800
,UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDRIONS TO THE GENERAL FEES
Center Pivot Irtiaation Boom
I THIS
BE
lul u W U W(I ��I �I �II u ul II III �I II) �� I UU
21056�15
Outdoor
ONE & TWO FAMILY DVJELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, M
Circuits and Two Inspection Tflps Each Dwe�irtg Unit @$80
total fee is
THISARFl FC
I his�cted tlie electricel tr�allatlon d� herein on fhe dat� stat�:
�`_��c
DISCONNECTED IF NOt COMPLETED WRHIN 12 MONTHS _
F4,1R �fFICE NLY
REC'D � UN - 2007
��b� � Ol C���-
D�: Rough-!n Inspecdon Required7 ❑ Y� ❑ No Insp�tlon Other Than Rough-In: � Ready Now O Wi0 CaA
� � You muat ceil the inapector when readyi Date Ready:
I certify that I am the � UCENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the electrical work at