P - 80556REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
' 1-380-337 � 1821 University Avenue Suite S�128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYlMRS 1-800-fi27-3529
www.electricify.state mn.us
FOR OFFICE lISE ONLY
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quest Date�. Rough-in Inspection Requiretl? ❑'/es ❑ Inspaction Other T�an Roug�-in: eatly Now � Will Call
���i %/�� Vou must c�ll �he inspector wM1en reaW! Da�e Peativ:
I cetlify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecincal work at: