P - 80558�
REpUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-380-339 � 1821 Universiry Avenue Suite S�128, Saint Paul, Minnesota 55104
(651) 842-0800 TTYlMRS 1-600-6273529
www. electricity. state. mn. us
FOR OFFICE USE ONLY
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�ate: Rough-in Inspeclion Requiretl? ❑ Yes ��❑ f Inspection plhe� Than Rough-in: eaEy Now
8�� ]�Q� Vou must call fie inspBCtor when reatly! Date Reativ:
I certily ihat I am the C� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he2by request inspection of the eleclrical work at: