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REQUEST FOR ELECTRICAL INSPECTION �°'E
Minnesota State Board of Electricity �� '�
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1821 UniversiTy Avenue Suite S-128, Saint Paul, Minnesota 551044993
(651) 642-0800 www.electricity.state.mn.us "�'
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Calculate Inspection Fee - This Inspection Request will not be accepted without fhe correct fee:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFICE USE ONLY This request void 18 months from validation date prinfed in ihis box.
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PLEASE PRINT OR TYPE
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