P - 81190.
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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.e/ectricity.state.mn.us
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Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
'X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
NSP SAVER'S S1A�iTCH IIVST'ALLATION
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 validadon date printed in Mis box.
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Request Date Rough-In inspection required7 ❑ Yes ❑ Inspection Other Than RougF�,ln: ❑ Ready Now ❑ Will Call
You must call the inspector when ready� Date Ready: ��
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I, [�0icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: