P - 79231REQUEST FOR ELECTRICAL INSPECTION
.1. � ( � � - 5 � 2 � Minnesota Board of Electricity - �?
1621 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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(651) 642-�800 TTY(MRS 1-8�0-627-3529 www.electriciry.state.mn.us
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Request Date: Rough-in Inspec1ion Required? CJ Yes Ll No Inspeaion OtF�er Than RouglNn: UReady Now LJ NlII Call
�7��� You must call the inspecta when ready! Date Reedy. _
I certify that I am ihe Q�ICENSED CONTRACTOR 0 COMPANY ❑ OWNER and he�eby request inspection of tl�e electricxl v�ro►k at:
INSTRUCTONS ON BACK OF YELLOW COPY B�ARD OF EIECTRICIN COPY EB-0ODOtA-74 8.1. 2002