P - 78659REQUEST FOR ELECTRICAL INSPECTION
1� 4? �- 7 91 � Minnesota Board of Electricity �
1821 Univereity Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricitystate.n{n.us
• EW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
ALARM, COMMUNIGAI IUN, KtMV I t l.Vlv i rcv�, a���
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus $.50
nnnirinNS Tn 7HE GENERAL FEES
to 12 Units
10
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All 8 O
Circuits and Two Inspeciion Trips Each Dwelling Unit �$BU
TOTALFEE I ��
(minimum total fee is $20)
rws ARFA FOR �IISPECTdi USE OKY
I hereby ceNy mat � inspected the electrical installa6on described heren on Me da�s staFeE.
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Request Date: Rough-in I�spection Required? Yes ❑ No Inspection Other Than Rough-In: ❑Ready Now � Will Call
5- 6- 0 3 You must call the inspecta when eady! Date Ready:
I certiry that l am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Jab Site Address (Street, Box, a Route No.) Zip Code
1142 NORTON AVE NE FRIDLEY
� � � �
����•.••" , ••••.�.,,...., ......._ License Number
WEST STAR ELECTRIC, INC. CA01936
ei�ing qddre.ss (Contraclor, Company or Owner Perfortning Installation) ,
� 6324 L KELAND AVE N BOROKLYN PAKR MN 55428
Sigpature (Con r, Company or Owner ing Installation) Phone (s) .
763-537-0807
187RU YELLOW COPY BOARD OF ELECTRICITY CAPV E&00001M14 8.1. 2002