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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us
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Calculate Inspection Fee - This Inspection Request will nof be accep►ed witl�out the correct fee:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
. OFFICE USE ONLY This request void 1 S monfhs from validation dafe prinfed in fhis box.
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l, 'censed contractor ❑ company ❑ owner hereby requesf inspection of the above electrical work at:
Address (Sheet, Box, or oute No.) Ciy ► Zip Code '
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Conkacfor License No.
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