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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. �Q�g`�'� ���� �,`�P��-�v�cE� y' �1'� 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. I������I���I�IIII��I�I��������I������������� ����� * � 9 3 6 6 8 9 �� �"��� 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: .IINIC �VNI'IU liVrl JCC IIY�IRUl.11V1YJ VIY OHI.I� VI' iCLLVYY l.Vl'1