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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
Mgmt.
Repair
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Calculate Inspection Fee - This Inspection Requesf will nof 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 months from validation dafe printed in ihis box.
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Request Dofe Rough-in inspection required$ ❑ Yes �No Inspecfion Other Than Rough-In: j�Ready Now ❑ Will Call
10-11-00 you must call the inspector when ready Dafe Ready:
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: