P - 82187� REQUEST FOR ELECTRlCAL INSPECTION �" �
�� � � � � � p � � � Minnesota� tate Board of Electricity �
C� 1821 Universi Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us "���
Home Duplex Apt.8ldg. Other: New Addn
Commercial Indusfrial Farm Remod Repair
Air Conditioner Hig. Equip. Woter Hfr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" pbove 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 nof be accepted without the correct fee:
THiS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validafion date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe . Rough-in inspection required$ ❑ Yes �lo Inspection Ofher Than Roughan: ❑ Ready Now ❑ Will Call
� �� � You must call fhe inspecfor when ready Date Ready: �� ���
I,'�.licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: