P - 80328U�892-554
Industrial
REQUEST FOR ELECTRICAL INSPECTION �
�[� Minnesota State Board of Electricity
�—�� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 _-
(651) 642-0800 www.electricity.state.mn.us `� �
Apt. Bldg. Other: New Addn
Farm Remod Reoair
Air Conclitionerl IHYg. Equip. Water Htr. Load Mgmt. f Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correcf fee:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OPFICE USE ONLY This request void 18 months 6om validation date prinfed in this box.
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PLEASE PRINT OR TYPE
2equest Dafe Rou h-in ins ion re uired? ❑ Yes
9 P� 9 ❑ No Inspection Orher Than Rough-In: Ready Now ❑ Will Call
3' � 2'7 -r ��Yj You musf call fhe inspecfor when ready Dafe Ready:
I,�icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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