P - 78664� REQUEST FOR ELECTRICAL INSPECTION
1� 412 - 7� 7 Minnesota Board of Electricity _
' 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.eleetricitystale.mn.us
�NEW D REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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ALAKM, t;UMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
$50 Per Un
Unit @ $25
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All $ Q
Circuits and Two Inspection Trips Each Dwelling Unit �$60
(minimum tofal fee is $20) � �
THIS AREA FOR INSPECTIX2 USE OKY
I hereby cer6ry that I inspected the electrical installaGOn described herein on Me da�s stated:
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I�II �III IIII� IIIII IIII� IIII) III�I IIII� �II� I�H �� �` 6
1 4 1 2 7 8 7 2 � S
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I certity that I am
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HOMES
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Rough-in Inspection Required? es ❑ No Inspection Other Than Rough-In: ❑Ready Now � VYII Call
You must call the inspector whe eady! Date Ready. ,
:NSED CONTRACTOR ❑ COMPANY ❑ OWNER and heieby request inspection of the electrical work at:
WEST STAR ELECTRIC, INC.
Mailing Address (CoMractor. Company or Owner Perfortnin9 Install
6 3 2;� LAKELA� AVE N BR
Author ignature (ConVa r, pany a Owner Perfortning I
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pN gACK OF YELLOW COPY /� BOARD OF ELECTRICITY COPY
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nse Number Master ElecViaan or Power Limited TecMiaan
License Number
136
�RK MN 55428
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Phone (5)
763-537-0807
E&OODO1M14 8.1.2002