P - 81120REQUEST FOR ELECTRICAL INSPECTION �
��� � g^- O 7 Q � Minnesota State Board of Electricity �'
�F O 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104•2993 �;
� (651) 642-0800 www.electricity.state.mn.us '�
Calculate lnspeciion Fee -
withouf the correcf fee:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validation date printed in this box.
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PLEASE PRIN OR TYPE
Requesf Date Rough-in inspection requi�ed^s ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑ Will Call
`� �� '�� You must call the inspector when ready Date Ready:
licensed controctor ❑ company ❑ owner hereby request inspection of the above electrical work af:
Jo�'ess (Sheet, x, or Route No.�� � � City Zi� e/
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Seclion No. Towns ip Name or No. Ranpe No. Fire No. Co /
Occupant
Power
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Phone No.
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Co hactor License No. Master Lic. No. �Plant
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Phone Number I
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SEE INSTRUCTIONS ON BACK OF YELLOW COPY