P - 75912REQUEST FOR ELECTRICAL INSPECTION �`
1= 9 9 9 4� 1� M82� University Aven e Suite S-� 8, ��M ���, Minnesota 55104
��`j�"�s�`r� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
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Describe -usigg�lie ba�k of th,e white copy if necess�s arv - the work covered by t�is requ�t:
CIRCUITS OF LESS THAN 50 VOLTS
Center Pivot
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INSTALLATION MAY BE ORDERE�
i I�I II �I � I� � III I� �1 II �I II III II �I �� i I�i
19994516
Su ptemental Fee $20
Transfomiers to 10 KVA a$10
Transformers over 10 KVA c$ 20
Transformer / Power Su I for Si / Outline Li $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Irrspeclion Trips Each Dwe�mg Unit @$BO
total fee is $20) I �J//. 5�
I inspeded the e ectrical mstallaflon d�ca�ed herein on flre da0es stat�:
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COMPLETED iMTHIN 72
fGR C�F�iJE USE C�ll'i
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��� Rough-in Inspecdon R�Wred? Yes ❑ No Inspectlon Other Than Rough-In: � Ready Now,� Witl Ce�tl
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You must cell the inspedor readyl Date R�dy.
I certify that I am the LICENSED CONTRACTOR ❑ CQMPANY ❑ OUdNER and hereby request inspe�tion of the electrical arork at
Job Site Sireet Address ��Y
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Contrador Licer�se Number MasteFElectricien or
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