P - 80162REQUEST FOR ELECTRICAL INSPECTION
� � � � � � � � � ° a e� Minnesota Board of Electricity � �°"° � .�
,' 1821 University Avenue Suite S-12S, Saint Paul, Minnesota 55104
� �,a� (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
FOR OFFICE USE pNLY
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Date: — I Rough-in Inspection Required? ❑ Yes No Inspe
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I cert'rfy that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wo�c at
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