P - 79321. > REQUEST FOR ELECTRICAL INSPECTION
��� 1 �- 5 8 6 0 Minnesota Board of Electricity -
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
�(��� �� ����� �� � I� ��� �� ��� ���� (� �� �� �����
R���1-
�,?7�58�1 �
�'
rceques[ ua[e: Rough-in Inspection Required? ❑ Yes ❑"IOo Inspection Other Than Rough-In: ❑I�ady Now � V1RII Call �
a�2��i You must call the inspectw when ready! Date Ready:
I certify that I am the ❑jCICENSED CONTRACTOR ❑ COMPANY ❑ OWNER aMf hereby request inspection of the electrical work at::