P - 79750REQUEST FOR ELECTRICAL INSPECTION
� � � � ("� � Z � p � Minnesota Board of EVectricity
lJ O 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
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Rough-in Inspection Required? CJ Yes Ll No Inspeclion Other Than Raugh-In: �Ready Now CJ Will Call
You must call the inspeclor when ready! Date Ready:
I certdy ihat I am ihe 'tJ LICENSED CONTRACTOR � COMPANY Cl OWNER and hereby request inspection of tt�e electrical work at::
IN87RUCTdIS ON BACK OF YELLOW COPY BOARD OF ELECTRIGTV COPY EB�W001M11 8.1. T002