P - 82180REQUEST FOR ELECTRICAL INSPECTION �
s� -� 19 - 0 6 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 '��
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy
Calculate Inspection Fee - This Inspection Request will not be accepted wiihout the correct fee:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MO_NTHS._"/
OFFICE USE ONLY This request void 18 monfhs from validation date printed in this box.
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R�e+quest Dqte Rough-in inspection required$ Yes ❑ No Inspection Other Than Rough-In: eady Now � Will Call
Ji �� You musf call ihe inspecfor.when ready Dafe Ready:
I, licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work ah
Job Address (Streef, Box, or Roufe No.) � City Zip Code �
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SEE INSTRl1CTIONS ON BACK OF VELLOW COPV