P - 786631-41,2-7�� �
[7aV�VJ ❑ REMODEL O ADDITION ❑
AIARM, COMMUNICATION, REMOTE CONTROt
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
$50 Per Unit
Unit � $25
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. eleCtriciry.state.mn. us
R Describe -using the back of the white copy if necessary - the xrork covered by this request:
�'�vu-v� FL�
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All 8 �
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Addi6onal Ins tion Tri $20
Investiaative Fee _
(minimum total fee is $20) � ��--' `
rH�s uten Fat irsvECTdt usE aar
I hereby cer6y that I inspected the electrical inst��ado� des��bed he�a^ on the dates sfa0ed:
; , ,;
I I�II II II� I� �II II III I� II� II II� II ���I �� I�
14127880 ��
� �j sa
Request Date: Rough-in Inspection Required? es ❑ Np Inspection Other Than Rough-In: OReady Now O VYdI Call
_ _ You must call the i�spector when dy! Date Ready
I certify that i am the ",�C'ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical wakat:
Job Site Address (Stree4 Box, or Route No.) Zip Cade
1124 NORTON AVE NE FRIDLEY
30287 �c� �
WEST STAR ELECTRIC, INC. I CA01936
nhng Address (Contractor, Company w Owner Performmg Installation)
� 4�,�`LAKEL�AJ�TD enA� E� �'n BR IOtOKLYN PAR� N
eonao oF e�crnicm coav
c�
Masier tiecmaan a Power Limited TecMician
���� �,m�.
55428
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763 537-0807
E&00001M74 8.1.2002