P - 79190REQUEST FOR ELECTRICAL INSPECTION
��� U O— 5 0 9� Minnesota Board of Electricity -
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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sc uare: . Roughin lnspedion Required? ❑ Yes �'No I lns
pection Other Than RougMn: ❑ dy Now
d7��� Ya� must catl the inspecta when readyl Date Ready.
I certify that I am the �CICENSED CONTRACTOR 0 COMPANY 0 OWNER and he�eby request inspeetio� of the electrical work at:
ma�nw iwna un ew�n ur �tuow coP� BOARD OF EIECTRICITY COVY EB-0OOOtM11 8.1.2002