P - 79997• REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-381-464 � 1821 Universiry Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651)642�0800 TTYlMRS 1-800-827-3529
www.electricity.sfafe.mn.us �-
FOR OFFICE USE ONLY
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Requeat �ate: Aough-in Inspeceon Required? ❑ Ves ❑ No Inspection Other Than Rough-in: 0 Reatly Now � Will Call
Q���ro� Vou mus� call ihe inspector when reaay! Da�e Reatly:
I cedify ihat I am ihe LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection ot [he elec[rical work at:
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