P - 81577- REQUEST FOR ELECTRICAL INSPECTION
�'� u 4 2��� 3 Minnesota Board of Electricity "°�
�� �b 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
° `� (651) 642-0800 TTY/MRS 1-500-627�529
www.electricity. state.mn. us
FOR OFFICE USE ONLY
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Request Date: �C Rough-in Inspection Required? es ❑ No Inspection 0
� 2�� v You must call the inspector when readyl Date Ready:
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Than Rough-In: ❑ Ready No�n
I certiiy that i am the �LICENSED COM'RACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of 1he electrical work at: