P - 79002REQUEST FOR ELECTRICAL INSPECTION
1 6 G 0- 5 9 2� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.etectricity.state.mn.us
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Request Date: Rpughin Inspection Required? ❑ Yes '�o Irupection Other Than Rough-In: dy Now 0 Will Call
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_Q You must call the inspector when ready! Date Ready. ,
I certify tt�at I am the ENSED CONTRACTQR �CON�ANY ❑ OWNER and hereby �equest �spection of 1he elecbic�l work at:
Job Site Address (Street, Box, or Route No.) Ciry Zip Code
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