P - 780421-524-390 �
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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-&27-3529 www.electricity.state.mn.us
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��c• /' � Rough-in Inspedion Required? ❑ Yes �NO Ins
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I cerMy that I am the O�CENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspecfion of the electrical work at::