P - 78117REQU�ST FOR ELECTRICAL INSPECTION
1— 5 7�— 2 9 7 a Minnesota Board of Electriaty
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn. us
IIII IIIII Ilill IIIlI IIIII IIIII IIIII IIIn �I� I�
15762974
�B� Roughin Inspedion Required7 LJ Yes
—�,�Q � You must call the inspeIXw when ready!
_
_ � 7�/ �
�
���� � ai��
o Inspedion Other Than RaugMn:
Date Ready.
d0 -sd
VVill Call
I certify ihat I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection d the electricxl work at: