P - 78057c REQUEST FOR ELECTRICAL INSPECTION
1� 5 3 3� U 11 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, SaiM Paul, Minnesofa 55104
(651)642-OSOOTTY/MRS1-800-627-3529 www.electricity.state.mn.us
�NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the bxk of ihe white copy 'rf necessary - the work covered by this request:
1163 NORTON — SPRINKLER ROOM FOR 6—PLEX
GENERAL FEES Outdoor Li h6n Standard $1
SERVICES I POWER SUPPLIES Traific Si nal Standard $5
0 to 400 Amcere (� 525 Suoolemental Fee �1$20
401 to 800 Am re 350
Above 800 Ampere @ $75
CUITS I FEEDERS
0 to 200 Ampere . $5
Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @ 5.50
ADDITIONS TO THE GENERAL FEES
Each AddiGonal
I Transformer I Power Supply for Signs / OuGine Lighting @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTALFEE
(minimum total fee is $20)
TNIS AREA Fpi INSPECiIX2115E OMY
� I hereby cer6ly that I inspec6ed the electrical installa6on described herein on the d�d:
FEES �� ��
per Mile I I
MAY BE ORDERED DISCONNECTED IF NOT COMPLETE
III) II III I) I� II ill II III II �II II II) II III �� I�
15336118
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Request Date: Rough-in Inspection Required? ' q/Yes LJ No Inspepion Other Than Rough-In: ❑Ready Now ❑ Will Call
1 0— 31 — 0 3 You must call the inspedor when �ady! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical work at::
Job Site Address (Street, x, or Route No.) City Zip Code
1163 NORTON AVE FRIDLEY
wner/Occupant Name ' � Please Provide l
P M J CONSTRUCTION ( )
ower Supplier Power Supplier Address
XCEL ENERGY
mVacta / Company Name Contrada License Number
WEST STAR ELECTRIC, INC. CA01936
lailin9 Address (Contratla. Comp�y or Owner Performing InstallaGon)
6324 LAKELAND AVE�N BROOKLYN PARK MN
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neaster t�eca�an a rrower umnea i ecnniaan
Uc�se Numbar
55428
cs>
763 537-0807
EB-OOOOtA-11 8.1.2002