P - 79202� REQUEST FOR ELECTRICAL INSPECTION �
`�J � � C p � [ � � � Minnesota Board of Electricity _
�L V O ..J 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
� �4sg9
! ��I� �' I�� � ��� �I ��' �� (I� 11 �� �� I�� � ��� �� ��� � ����
1 7 6 8 5 2 2 3
����� , ����� �� � •S�S
Request Date: I Rough-in Inspection Required? ❑ Yes Ll �Pfo Inspection Other Than Rough-In: ❑Ready Now LJ V1MI Call
07�d� You must call the inspecta when ready! Date Ready:
I certify that I am tt�e ❑�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
INBTRUCTONS ON BACK OF YELLOW COPY BOARp OF ELECTRICT' COPV E&00001M71 8.1. 2002