P - 81834i�oss-129 ��sw
tdentify the work covered by this request:
$1 NEW ❑ REMODEL ❑ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
800 Ampere �
/FEEDERS
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity '�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity. state.mn. us
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Retroffi � $25 oer Fixture
Park Sites �
�pection"� $2�
$30 cer Hour
Tranc Sianal Standard �
Transiormer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All 5. 5 �
Circuits and Two Inspection Trips Each Dwellin Unit �$80
Addirional Insoection Trios � $20
Fee
total fee is $201 � 8 5. 5�
an tlie �es �ted:
FOR OFfICE tISE ONLY
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Request Date: Rough-fn Inspection Required? Yes ❑ No Inspection O�er Than Rough-In: ❑ Ready Now ❑ wll Call
5-17 — 01 You must call the inspector when reatlyl Date Ready:
I certiry that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, B x, or Route No.) Ciry Tap Code
5800 SECOND ST N.E. FRIDLEY
Seciion Twmship Hange Fire No. County
Oxupant Phone
PMJ GROUP r. 763-635-8155
Power Supplfer �
XCEL Y
Electrical Contractor / Company Name Contrador License Number Master License Nur�er
WEST STAR ELECTRIC, INC. CA01936
Mailing Address (Contradw, Company or Owner Performing Installatlon)
6324 LAKELAN AVE N BROOKLYN PARK MN 55428
Autho' ed igtt�ture (Contre Co pany or Owner Performing Installadon) Phone
763-537-0807
EB-OOOOtA- BOMD OF ELECTAICRY COPY INSTRUCTIONS ON BAd( OF YELLOW COPY