P - 76008R�QUE�T FOR ELECTRICAL INSPECTION °���'
��� L o� 411 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TlY/MRS 1-800-627-3529 www.eleclricity.state.mrt.us
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SUPPLIES
0 to 400
CIRCUITS OF LESS THAN 50 VOLTS
Cer�er Pivot Irriaation �om
INSTALLATION MAY BE ORDERED D
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18204115
Ttaffic Sipnal Standard
Indudes the Service andlor Paver Suppry up to 500 Amperes, All
Circuits and Two Insp�tion Tdps Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Inv�stivative Fe.e
total fee is
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.TED IF NOT COIIAPLETED WITHIN 12 MONTHS
=4�P, t1FFiCE USE 17tv��
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�� Rough-in InspecHon R�ulred9 ❑ Y� ❑ No InspecUon Other Than Rough-In: � Ready Now �Nt@ Call
�` p� ��'V You must call the inspector when readyl Date Ready.
I c�rtify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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To�msh(p S�Uon Range FlreNo. CouMy��D��
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mpany or
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License Number I Mester Electric3an or
Llcemse Number
or Owner Pertormin I�t8118UOt1) Please P�avltle TWO (2) PhOI1B NUrtibers
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