P - 79240° REQUEST FOR ELECTRICAL INSPECTION
��� V O- 5 71� Minnesota Board of Electricity -
�. 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
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Request Date: � Rough-in Inspection Required? ❑ Yes �"No Inspection Other Tha� Rough-In: OAeady Now O Will Call
�7��� You must call the inspector when ready! Date Ready.
I certify that I am the Q)CICENSED CONTRACTOR ❑ COMPANY Q OWNER and hereby request inspecbon of Uie elecfica! work at:
INSTRUC710NS ON BACK OF YELLOW GOPY BOARD OF ELECTRICT' CAPV EB•OOOOfM14 &7. T002