P - 75996REQUEST FOR ELECTRICAL INSPECTION
1� 5� o-� 3 5� Minnesota Board of Electric�ty
1821 University Avenue Sufte S-128, Sairrt Paul, Minn�ota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
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� ua[e: Roughan Inspection Required? �4�es ❑ No Irep�ion Ofher Than Rough-In: �Ready Now�' Ifll Call
� You must call the inspeet� when readyl Date Ready. .
I certify tliat I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER er� hereby request mspection of fhe electrical work at: