Fillable Please submit a separate application for each electrically (North Dakota State Electrical Board)

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Please submit a separate application for each electrically (North Dakota State Electrical Board)

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• Please submit a separate application for each electrically driven irrigation machine.
• Application inspection fee is $50.00 and must accompany this application.
Manufacturer
Model or Serial Number
Size
Dealer
Telephone Number
Address
City
State
ZIP Code
Owner’s Name
Telephone Number
Address
City
State
ZIP Code
LOCATION OF STRUCTURE – ADDRESS OR LEGAL DESCRIPTION
Address
State
Township
Range
Section
Quarter
Give Directions if Site Address or Legal Description is Not Available
Estimated Completion Date
Name (First, Last)
Company
Title
Address
City
State
ZIP Code
Work Telephone Number
Cell Phone Number
Signature
Date
Submit completed application to:
North Dakota State Electrical Board Phone: 701-328-9522
PO Box 7335 Fax: 701-328-9524
Bismarck, ND 58507 Email address: electric@nd.gov
Website: www.ndseb.com
APPLICATION FOR INSPECTION OF ELECTRICALLY DRIVEN
IRRIGATION MACHINE
NORTH DAKOTA STATE ELECTRICAL BOARD
SFN 61921 (12-2020)
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Completed 21 April 2021

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