P - 77247F;EQUEST FOR ELECTRICAL INSPECTION
1� 7 3� � 5 7 � Minnesota Board of Electriaty
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651)642-080011Y/MRS 1-800-627-3529 www.electricilv.state.mn.us
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�uest Date: Rough-in Inspection Required? ❑ Yes
1�(} l 1` � You must cail the inspeeta when ready!
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Insped'qn Other Than RougMn: LlReady Now ,L�Will Call
Date R�dy: .
I cer6fy lhat I am 1he �16ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he►eby request inspection of Ihe electrical work at: