P - 81983REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity "
1-377-491 � 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: I Rough-in Inspection Required?
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FOR OFFICE USE ONLY
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❑ Inspectlon Other Than Rough-in:
Date
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: