P - 80242E�-S�"�J1-556
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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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"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspecfion Request will not be accepted withouf the correcf fee:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validafion dafe prinfed in ihis box.
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PLEASE PRINT OR TYPE
Request Date^^ j�y� Rough-in inspec}ion required$ ❑ Yes o Inspection Ofher Than Rough-In: �eady Now ❑ Will Call
�-�1�1^� You must call the inspecfor when ready Dafe Ready:
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Section No.
Occupa�t 1
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Power Suoo
�sed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
(Sheef, Box, or Route NoJ. City Zip Code
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or
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(Contr cfor, Company or Owner P
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ture (Con}racfor, Company or O_vi
Phone
License No. I Masfer Lic.
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EB-00001A-12 5/1999 STATE H04RD C�PV SEE INSTRUCTIONS ON BACK OF YELLOW COPY