P - 82144REQUEST FOR ELECTRICAL INSPECTION ���
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Minnesota State Board of Electricit
, 7821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us "��
Air Conditioner Htg. E
Dryer Range
"X" above the work co�
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Farm
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
is request. Enter remarks in this space
on
copy
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Repair
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validafion dafe prinfed in this box.
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PLEASE PRINT OR TYPE
contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
STATE BOARD COPY
SEE INSTRUCTIONS ON BACK OF YELIOW COPY