P - 77023REQUEST FOR ELECTRIC� INSPECTION
1� 6� 5- 9 3 0� Minnesota Board of Electricity ��� �j `(1�1��'(�
1821 University Avenue Suite S-128, Sai aul, Minnesota i'6
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
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16859308
�te: Rough-in Inspeclion Required? ❑ Yes No Ins
^ pedion Other Than Rough-In: ❑Ready Now Will Call
e� �, D� Yau must call the inspeUa when ready! Date Ready:
I certiiy that I am the f�'LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of tlie electrical work at: