P - 80528�O��J REQUEST FOR ELECTRICAL INSPECTION �T"E�9�
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� (651) 642-0860 www.e�ectricity.state.mn.us ��'���'�" F
"X" above the work covered by this reqvest. En er i
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Calculafe Inspection Fee - This Inspeciion Request will not be accepted wiihout the correct fee:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIIV�8 MONTHS.
OFFICE USE ONLY This request void 18 months from validotion dahe printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inapectian required? ❑ Yes ❑ No Inspection Other Than RougMln: ❑ Ready Now Will Call
�-1�� �\ You must call the inspector when ready Date Ready:
1, ' licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
1ob Address (Street, Box, or Route No.) Ci Zip Code
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Power
or No. � � Range No. � Fire No.
or
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Phone No. ' '
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No. ,� � Master Lic. No. (Plant Elecf.
STATE BOARD COPV SEE INSTRUCTIONS ON BACK OF VELLOW COPV