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REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of ElecViaty
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
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�� �e� Rough�n Inspection Required7 ❑ Yes ❑ No Inspedion Other Than Rough-In: eady Now ❑ Will Call
�•�� • You must call the inspeUa when ready! pe� �y;
I certiy that i am the �ICENSED CONTRACTOR ❑ COIu�ANY ❑ OWNER and hereby request inspection oi the eleclrical work at:
Job Site (Street or Rout .) CitY Lp Code
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HOLMQUI3T CONTRACTII�T(3
7056 POLARI3 LN NO.
MAPLE dROVE, MN SS311
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