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REQUEST FOR ELECTRICAL INSPECTION ��¢o
Minnesota State Soard of Electricity 3
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55Y04-2993 ��r
(651) 642-0800 www.electricity.state.mn.us `���
Home Duplex Apt. Bldg. Ofher: New Addn
Commercial Indusfrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. 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 not be accepted wiihout the correct fee:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COAAPLETED WITHIN 18 MONTHS.
_, � OFFICE USE ONLY This requesf void 18 monfhs 6om validafion dafe prinfed in fhis box. -
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PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspecfion required? ❑ Yes o Inspection Ofher Than Rough-In: ❑ Reqdy Now �Will Cal)
� Q� You musf call fhe inspector when ready Dafe Ready: � �
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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Section No. Township Name or No. Range No. Fire No. CounN
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ontrador / Company Name
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dress (Confracfor, Compan or Owner Performing
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Signature onfra r, �ompany or Owner Perfon
Phone No.
Conhactor License No. Master Lic. No.
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