P - 79239REQUEST FOR ELECTRICAL INSPECTION
1 ` � C � � [ � (� � Minnesota Board of Electricity �
C� J �y/ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55704
, (651) 642-0800 TTYIMRS 1-800-627-3529 www.electricity.state.mn.us
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Re�ues� �ace: Rough-in Inspeclion Required? ❑ Yes ❑ 7�10 inspection OMer Than Raugh-In: ❑ Now O VWt CaN
�7�� You must call the inspector when ready! Date Ready:
I certify tl�at I am fhe OISICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspect+on of the elecUical work ak:
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