P - 82627REQUEST FOR ELECTRICAL INSPECTION �
U���~� �- 6 8 9� Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 �����
� � (651) 642-0800 www.electricity.state.mn.us `'�'
ome Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod epair
ir Cond' tg. Equip. Water Htr. Load Mgmt. 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 only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLV This requesf void 18 months from validation date printed in fhis box.
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PLEASE PRINT OR TYPE
Requesf Date Rou h-in ins eciion re uired?
g p q ❑ Yes �lo Inspection Ofher Than Rough-In: ady Now ❑ Will Call
��lj�'�Q �% You musf call fhe inspecror when ready � Date Ready:
I;�licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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