P - 81210(�=881-Q74
Commercial
REQUEST FOR ELECTRICAL INSPECTION
� Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 �����
(651) 642-0800 www.electricity.st�te.mn.us `'°�'
Aot. Blda. Other: New Addn
Farm
Air Conditioner tg. Equip. Water Htr. Load Mgmf. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of
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copy
Calcula►e Inspection Fee - This Inspec►ion Request will not be accepfed withovt the correct fee:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in fhis box.
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PLEASE PRINT OR TYPE
Reqvest Dafe Rough-in inspection required8 ❑ Yes -� Inspection Other Than Rough-In: �ady Now ❑ Will Call
�, �`�—� q You must call the inspector whan ready Date Ready:
�licensed contractor ❑ company ❑ owner hereby request inspectio� of the above electrical work at: