P - 80393REQUEST FOR ELECTRICAL INSPECTION
('� � � � � � � � � � Minnesota State Board of Electricity � �'
1821 University Avenue Suite 5-128, Saint Paul, Minneso[a 55104-2993
�651) 642-0800 www.e%ctricity.state.mn.us " '
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Colculate Inspec►ion Fee -
will no� be accepted without the correct fee:
THiS INSTALLATION MAY BE ORDERED DISCONN�CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validafion dafe printed in this box.
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PLEASE PRINT R TYPE
Req�esf Dafe Rough-in inspection required$ ❑ Yes ❑ No Inspection.Ofher Than Rough-�n: Ready Now ❑ Will Call
-�� You must call the inspecfor when ready Dafe Ready: .
, ' ensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work ar:
Jo Address �Street, Box{or Route No.� Ciy /� Zip Code
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Seclion No. lownship Name or No. � Range No. Fi�e No. CountyQ
Occupant � Phone No.
Power Supplier Ad ress
Electrical Conhodor / Company ame Confractor License No. Ma:
Signafure
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COP
Number
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INSTRUCTIONS ON BACK OF YELLOW COPY