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Farm
Conditioner � � Htg. Equip. � � Water Htr.
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite S-728, Saint Paul, Minnesota 55104-2993 i���i
(651) 642-0800 www.electricity.state.mn.us '� '
Addn
Repair
Dryer I I Range I I Elec. Heat I I Temp. Service I
„X" above the work covered by this reqvesf. Enter remarks in this space and on the back of the white copy only.
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Calculaie Inspection Fee - This Inspeciion Request will not be accepted wiihout the correci fee:
THIS INSTALLATION MAY BE ORDERED_DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ONLY This request void 1 S months from validation date printed in this box. �
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PLEASE PRINT OR TYPE �
Requesf Da / � Rough-in inspecfion required2 �es ❑ No Inspecfion Other Than Rough-In: ❑ Ready Now �Q(ill Call
'�`J� �� � You musf call fhe inspecror when ready Dafe Ready: �
I, D licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: