P - 79204REQUEST FOR ELECTRICAL INSPECTION
� r� V O- 5 2 4� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
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Request Date: Rough-in Inspeclion Required? ❑ Yes ❑"No Inspedion Other Than Rough-In: OF2eaCy Now tJ VNN Call
a��0� You must call the inspecta when reaEy! Date Ready:
I certify that I am the dCICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecdon of tt�e electriql work at:
INBTRUCTONS ON BACK OF VELLOW COPY BOARD OF ELECTRICITY COPV EB-00001M14 8.1. 2002