P - 82154REQUEST FOR ELECTRICAL INSPECTION ��
��� � � � � � 2 � � � Minnesota State Board of Electricity
1821 University Avenue Suite 5-128, Sain[ Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us '���"
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other;
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in fhis space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
THIS INSTALLA710N 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
Requesf.Dafe Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: Ready Now 0 Will Call
S- „—e� You must call the inspector when ready Dote Ready: �"� ����-Q
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: