P - 80334REQUEST FOR ELECTRICAL INSPECTION
��' Minnesota State Board of Electricity ��
- 8 9 2- 5 6 5� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 �
(651) 642-0800 www.electricity.state.mn.us "��
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Commerc
Apt.
Repair
Air Conditioner Htg. Equip. WaTer Htr. Load Mgmt. Other:
Dryer Range Elec. Heaf Temp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculaie Inspection Fee - This Inspec►ion Requesi will not be occepted without the correct fee:
THIS INSTALLATION MAY BE ORDERED DISCOMIJECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This �equesf void 18 months hom validation date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe � Rough-in inspection required? ❑ Yes ❑ No Inspection Ofher Than Roughan: Ready Now 0 Will Call
Q You musf call the inspecfor when ready Date Ready: .
I, �icensed contractor ❑ company ❑ owner hereby request inspection of the above electricol work ot: