P - 78373....�- .
REQUEST FOR ELECTRICAL INSPECTION
1 3 6 5 12 5 ; ee Minnesota Board of Electriciry
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
ex � (651) 642-0800 TTY/MRS 1-800-627-3529
� www.electricity.state.mn.us
FOR OFRCE USE ONLY
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R t Date: � Rough-in Inspedion Required? Yes ❑ No InspecUon Other Than Rough-In: Ready Now II Call
� V You must call tlie inspector when ready! Date Ready:
I certify that I am the IICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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INSTAUC710N8 ad BACK OF YELLOW 1