P - 82103REQUEST FOR ELECTRICAL INSPECTION �°'E�
`1 � 918 - 2 9 2� Minnesota State Board of Electricity �-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 �
(651) 642-0800 www.electricity.state.mn.us "���
the white copy only.
without ►he 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
Requesf Date� ��� Rough-in inspection required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
You musf call fhe inspector when ready Daie Ready:
I, �licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: