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❑ REQUEST FOR ELECTRICAL INSPECTION `° `
�.+ 1� J- 5 8 4 6 Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.e[ectricity.state.mn.us
Request Dffie: Rough-in Inspedion Required? ❑ Yes Q�No I Inspedion Other Than Rough-In: ��ady Now ❑ Will Call
pg/2Q(pq You must call ene inspeaor wnan reaay! Date Reaay:
I certify that I am the L�ICENSEO CONTRACTOR ❑ COMPANY ❑ OWNER a� hereby �equest inspection of the electrical wo�c at:
IN87RUCTONB ON BACK OF YELLOW GOPY BOARD OF ELECTRICRY CAPY E6-0OOO7M70 8.1. 2uu2