P - 77550✓
REQUEST FOR ELECTRICAL INSPECTION
1��`t O- 7 2 6 3❑ Minnesota Board of Electricity p� �Q�- d/� y
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
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Qy Roughin Inspection Required? ❑ Yes �Q�No �nspedipn p�her Than RougMn: �tEady Now ❑ Wfll Call
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J You must call the inspector when ready! Date Ready:
that I am the LICEN$ED CONTRACTOR �❑ COMPANY ❑ OWNER and hereby request inspection of Ihe electrical work at:
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