P - 82488(���86-312 �I
REQUEST FOR ELECTRICAL INSPECTION �
Minnesota State Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 ���
(651) 642-0800 www.electricity.state.mn.us `' '
Home Duplex Apt. Bldg. Other:
Com ial Indusirial Farm
Ai C� r Htg. Equip. Water Htr. Load Mgmt.
D Range Elec. Heot Temp. Service
"X" above the work covered by this request. Enter remarks in tF
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space and on the back of th�
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New Addn
Remod Repair
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
only.
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITNIN 1S MvN71i5.
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OFFICE USE ONLY This request void 18 months from validation date printed in fhis box.
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� PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspection required? ❑ Yes �{ lo_ Inspection Other Than�RougMn:�Ready Now � Will Calf
1��� You must call the inspector when ready Date Ready: /b� '��m
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I, �licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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