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P - 80327`U-892-566 [� Home Apt. REQUEST FOR ELECTRICAL INSPECTION Minnesota State Board of Electricity � 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 ��� (651) 642-0800 www.electricity.state.mn.us Air Conditioner Htg. Equip. Water Hir. Load Mgmt. Other: Dryer Range Elec. Heat Temp. Service "X" above the work covered by this request. Enter remarks iri this space and on the back of the whiie copy ���r�-�/ 5��� � —�✓ �� � l c� E� . �� -f-r� (.� � �� �On�z�-h�r� Calculate Inspection Fee - This Inspection Request will not be accep►ed without the correct fee: THIS INSTALLATION MAY BE ORDERED DISCONNEGTED IF NOT GOMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This request wid 18 months from validation date printed in this box. I 1�� �/�1 � III II� I�1 1, tl, ��.I� I���� * 0 8 9 2 5 6 6 L* I Date Rough-in inspecfion required? ❑ Yes ❑ No i��� 0O You must call the inspecror when ready � a5 � � 7/� PLEASE PRINT OR TYPE Inspecfion Ofher Than Rough-In: �eady Now ❑ Will Call Date Ready: l,�licensed contractor ❑ company ❑ owner hereby request inspection of the above elechical work at: