P - 761171 7 8 7 O 3 9 a REQUEST FOR ELECTRICAL INSPECTION
� � 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.trs
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�� Rough-in Inspection Required? ❑ Ye �] No Inspection Other Than Rough-In: [�SFteady Now ❑ Will Call
$, �. 4�06 You must call the inspector when ready! Date Ready:
I c�Rify tt�at I am the L�J LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at