P - 79230REQUEST FOR ELECTRICAL INSPECTION -
`� �( V Q_ 5 61 �j Minnesota Board of Electricity -
V 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTYIMRS 1-800-627-3529 www.electriciry.state.mn.us
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspedion Other Than Rough-In: Dl�eady Now G Will Call
����� Ycu must call the inspector when ready! Date Ready.
I certi(y that I am the �ZCICENSED CONTRACTOR ❑ COMPAM' ❑ OWNER and hereby riequest inspection of tl�e electrical work at::
INSTRUCTONS ON BACK OF YELLOW COPV BOARO �F EIECTRICITY COPY EB-00001A-14 8.1. 2002