P - 82139�
U�940-307 �
REQUEST FOR ELECTRICAL INSPECTION ��-
Minnesota State Board of Electricity
1821 University Avenue Suite S-Y28, Saint Paul, Minnesota 55104•2993 ��
(651) 642-0800 www.electricity.state.mn.us �
Apt. Bldg. Other: New Addn
Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heaf Temp, Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the whiie copy
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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.
s OFFICE USE ONLY Thia requsst wid 1 S months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Dat� Rough-in inspection required$ ❑ Yes No Inspection Other Than Rough-In: Ready Now ❑ Will Call
/y 6� You musf call fhe inspecfor when ready Date Ready:
I,,.�licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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