P - 77201REQUEST FOR ELECTRICAL INSPECTION
1� 7 31- 5 0 2� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651)642-0800TTY/MRS1-800-627-3529 www.electricity.state.mn.us
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ecequest uate: Rough-in Inspection Required? 0 Yes ❑ No Inspedion Other Than Rough-In: OReady Nov�y�lll Call
You must call the inspecla when ready! Date Ready:
I ce�tify that I am the �CENSED CONTRACTOR ❑COMPANY ❑ OWNER and heieby request inspection of the electricxl work ai:
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