P - 79447REQUEST FOR ELECTFi1CAL INSPECTION
1 � O I O�� , Minnesota Board ot Electricdy
� 1� 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 ���
"": (651) 642-0800 TTY/MRS 1-800-627-3529
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I oNEw
OF LESS
❑ FEPAIR
Indudes ihe Service anNor Power Suppty up to 500 Amperes, All
Circuits and iwo Inscection ir'ros Each DweAirw Unit �$BC
Fqi OFFICE USE ONLY
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I �f �`T � Vou must call fie inspector w�en reatly!' � Da[e Reatly: �
I certity ihat I am ihe g� �yI;ENSED CONTRACTOR ❑ COMPANY ❑ OWNER aM
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tatal fee is
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)MPLETED WITHIN 18 MONTHS
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71i n R u -In, y Now Q Will Call
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a by re uest inspection of the Nec[ncal work at
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Mas[er License Number
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INSTNUCTIONS ON BACK OF YELLOW COPY