P - 80577� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board ot Electncity
1-380-308 � 1821 University Avenue Suite S428, Saint Paul, Minnesoia 55104 �'
(651) 642-0800 TTYlMRS 1-800-627-3529
www.electricitystate.mn. us
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Requeat Date: Rough-in Inspec�ion Requiretl? ❑ Ves ❑ Inspection Other Than Rough-in: eatly Now O Will Call �
Vo� mus� call ihe inspector when reatly! Oate Reatly:
I cetlily that I am ihe � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electncal work at: