P - 82416REQUEST FOR ELECTRICAL INSPECTtON �
(� � �'p � � � � 2 � Minnesota State Board of Electricity
l.l �., � C,) 1821 University Avenue Suite S-128, Saint Paul, Minnesot2 55104-2993
(651) 642-0800 www.electricity.state.mn.us '� '
ome Duplex Apt. Bldg. Other. New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Wafer Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this sppce and on ihe back of the white copy only.
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Ca cu ate Inspection Fee - This Inspection eq st w�ll ot be accepted withou� 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 this box.
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PLEASE PRINT OR TYPE
Request Dat //��� Rough-in inspection required$ ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
You must call the inspector when ready Date Ready:
l,�icensed contractor ❑ company ❑ owner hereby request inspection of the above elechical work at: