P - 78070REQUEST FOR ELECTRICAL INSPECTION
1� J��- 5 9 3� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
NEW 0 REMODEL � ADDITION 0 REPAIR Describe -using fhe back of ihe white copy 'rf necessary - the work covered by this request:
GENERAL FEES Outdoor Li htin Standard 51
SERVICES / POWER SUPPLIES Tralfic ' nal Sfandard E5
0 to 400 Amcere � 825 C����w„a��ai F� n e�n
CIRCUITS
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus 5.50
ADDITIONS TO THE GENERAL FEES
2 Units @ $50 Per Unit
Addition� Unit � 325
�ER ADDITIONAL FEES
25 per Fixture
i Boom @ S40
Park Lok � $25
Park Sites � S5 h
I NII B I� II III II !►1 II III II ill Ii lll II III N� I�
15335938
Transfortner I Power Su fa S' ns I Outline ' hfin y5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All $ rj . rj
Circuils and Two Inspection Trips Each Dwelling Unit @ S80
(minimum total fee is $20) � 8 5. 5 0
rHa na&, Foa rue�crat usE par
I hereby ceNry that I inspec0ed the electrical installaAOn described Mxein on the dates stated:
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rceywsi ua�e: Rough-in Inspetlion Required? � Yes ❑ No Inspection Other Th� Rough-In: �Ready Now O WNI Call
1 0— 2 0— 0 3 You must call the inspedor wh� ready! Dale Ready.
I oerti(y that I am the LICENSED CONTRACTOR 0 COA�PANY ❑ OWNER and heieby request inspection of the elecUical work at:
Job Site Address (Sfreet aox. or Route No.) City Lp Cade
1163 NORTON AVE FRIDLEY
hvner/OaapeM Neme C Please Pruvide Two (2) Phone Number(s) Induding Area Cc
PMJ CONSTRUCTION � � ( � � �
ower supp�ier Powe. supp�ia naaress
XCEL ENERGY
onaacWr � canpany ►dame convacror Licenae Mumber Masrer �ectriaen « Power Limired rear
WEST STAR ELECTRIC, INC. CA01936 �''�"�
lei�:,g naaress cconaaa«, ca„par,y «owr,er Pe�tomwng risf�a,�
63 LAKELAND A N BROOKLYN PARK MN 55428
(conaacror, , «owner aar«m:,g �nstenation) Pl,one (s)
�' 763 537-0807
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