P - 82161REQUEST FOR ELECTRICAL INSPECTION ��
R�' (►^�� Minnesota State Board of Electricity �
�� 7�+✓ ���� � v �- tg21 Universiry Avenue Suite 5-128, Saint Paul, Minnesota 55104•2993 - F
' (651) 642-0800 www.electricity.state.mn.us ?�'"
Home Duplex Apt. Bldg. Ofher: New Addn
Commercial Industrial Farm emod Repair
Air Condifioner Htg. Equip. Water Hic Load Mgmt. Other.
Dryer Ronge Elec. Heot Temp. Senice
"X" above the work covered by this request. Enter remarks in this space and the back of the white copy only.
� �cY> C � � —du�P/� �� t-1 � ����
� �
Calculate Inspection Fee - This Inspection Request wil( not be accepied withouf ihe correct fee:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHiN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validation da�e p�'nted i� box.
��II����N��III�� ._ • `�U.
�I���C�II
� 0 8 7 2 5 1 6 D� ��7/
PLEASE PRINT OR TYPE
Requesf Dafe Rou h-in ins ecfion re uired? Yes
�r ��_�� g p q ❑ No Inspection Other Than RougMn: ❑ Ready Now ill Call
You must coll ihe inspector when ready Date Reody:
l, icensed confractor ❑ company ❑ owner hereby request inspecfion of the above electrical work at: