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REQUEST FOR ELECTRICAL INSPECTION �T"E
� Minnesota State Board of Electricity � �3
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 ������
(651) 642-0800 www.electricity.state.mn.us ���?m�
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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 ONLY This request void 18 monfhs from validafion dafe printed in fhis box.
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PLEASE PRINT OR TYPE
� Rough-in inspecfion required? ❑ Yes�No Inspecfion Ofher Than Rough-In: ❑ Ready Now ❑ Will Call
��%� You must call the inspector when ready Date Ready:
censed contractor ❑ company ❑ owner hereby request inspection oF the above electrical work at:
a � w � t es�wnu cuYT �tt INS I FIUG I IUNS UN tlAGK UF YELLUW GOPY