P - 78774REQUEST FOR ELECTRICAL INSPECTION
�� 4�, 5�� 8� � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 T1Y/MRS 1-800-627-3529 www•electricitystate.mn.us
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Req�uesjt Date���� Rough-in InspecUon Required? Yes ❑ No Inspection Other Than RougMn: ❑Ready Now Will Call
/ You must cail the inspecla when readyl Date Ready:
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I certi(y tl�at I am tl�e �LICENSED CONTRACTOR �COIuIPANY ❑ OWNER and hereby request mspection of 1he electrica� wak at:
Job Site Address i Box a fmute No.) ily ZiP Code
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