P - 81851f 1-375-411
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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 1-500-627-3529
www. e%ctricity.state.mn. us
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FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ Inspection Other Than Rough-in: eady Now ❑ Will Call
You must call the inspecTOr when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY p OWNER and hereby request inspection of the electrical work at: