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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validafion dafe prinfed in this box.
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PLEASE PRINT OR TYPE
Date RougfFin inspection required� ❑ Yes ❑ No Inspection Other Than RougMn: �eady Now �❑ Will Call
'� �'��� You must call the inspector whan ready Date Ready:
I,%�licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: