P - 80366U�89�-445 �
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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity �'
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 =
(651) 642-0800 www.electricity,state.mn.us
Apt. Bldg. Other: New Addn
Farm Remod Repair
Water Hir. Load Mgmt. Other:
Dryer I I Range I I Elec. Heaf I I Temp. Service I
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy
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Calculate inspection Fee - This Inspection Request will not be accepfed wiihout the correct fee:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. ____
OPFICE USE ONLY This requesf void 18 months From validation date printed in this box. �
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Request Date Rou h-in ins eclion re uired? ❑ Yes
g p q ❑ No Inspecfion Other Than Rough-In: Ready Now ❑ Will Call
Z,r 1� � r� r� You musf call fhe inspector when ready Date Ready: �
I,� licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: