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Air Conditioner� �Htg. Equip.
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite S-728, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us
Apt. Bldg. Other. Ne�
Farm �� ��� Rem
Water Htr. Load Mgmt. Other:
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Repair
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will noi be accepted without the correci fee:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs from validation dafe printed in fhis box.
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� Requesf Dafe Rough-in inspecfion required? � Yes ❑ No Inspection Ofher Than Rough-In: ❑ Ready Now�Eall
� i� Tj� You musf call the inspecfor when ready Date Ready: �
I, �'fttensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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