P - 80591� REQUEST FOR ELECTRICALINSPECTION
Minnesota Board of Electriciry
1-380-323 � 1821 Universiry Avenue Suite 5�128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYIMRS 1-800-627-3529
www. elect�iciry. sta te. mn. us ..
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Request �ata: RoUgh-in Inspectlon Required? ❑Yes ❑ Inspection O�her Than Rough,in: eady Now 0 Will Call
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I certify that I am the � LICENSEO CONiRAC70F ❑ COMPANY ❑ OWNER and hereby request inspection W the elecMcal work at: