P - 78657*� REQUEST FOR ELECTRICAL INSPECTION � � .
1�� 1�- 7 9 3� Minnesota Board of Electricity :
�, 1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-OB00 TTY/MRS 1-800-627-3529 www.electriaity.state.mn.us
�pEW ❑ REMODEL ❑ ADDITION 0 REPAIR Describe -using the back of ihe white copy if necessary - the work covered by this request:
400
GRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Eac� Svstem Device or Aooaratus �$.50
3 to 12 Unils
Center Pivot Irr�aUon Boom
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1 4 1 2 7 9 3 0
Trafic Sional Standard
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT I
includes ihe Service and/or Power Supply up to 500 Amperes, NI $ Q
Grcuits and Two Inspection Trips Each Dwelling Unit � E80
TOTALFEE "
(minimum total fee is $20)
TMS IJIEA Fpi NSPECTOR USE OKY
I hereby certiy that I inspected tlie electical instaN�on de�ibed herein on tlie da�es sfa6ed:
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nequas� ua�e: Rough�n Ir�spection Required7 qyYes LJ No Inspection Oth� Than Rough-In: LJI2eady Now LJ Wdl Cap
5— 6— 0 3 You must call ttie inspecla wh� reedy! � r�cr .
I ceAiy that I am tlie LICENSED CONTRACTOR ❑ COA�ANY ❑ OYIMER and heieby request inspection of tl�e electrical wak �:
Jati 5de Addreas ( Bm4 or Route No.) Zip Code
1154 NORTON AVE NE FRIDLEY
� �
WEST STAR ELECTRIC, INC. � CA01936
ai�ing �aaes$ �ca,aador. company w owr,er Pe�romrirg mStaUeuo�)
b�2 4 LAKELAND-�AVE N BROOKLYN PARK MN
Signeture (CoMra . nv a Owner Perfonnirw Instellafionl P
ELECiRICRV COPV
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Master Bectriaen or Power Limieed eduueian
u�en� rr,mce►
55428
: (s)
763 537-0807
E&00001M14 &1.2002