P - 78071REQUEST FOR ELECTRICAL INSPECTION
1 .a� ��� 5 9 4 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TT`f/MRS 1-800-627-3529 www.electricity.state.mn.us
�NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy 'rf necessary - the work covered by this request:
CIRCUITS OF LESS THAN 50 VOLTS
Svstem Device or Anoaratus � E.50
3 to 12 Units
Supplement� Fce
Transformers uo tc
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT �
Includes ihe Service andlor Power Supply up to 500 Amperes, All Q
Circuits and Two Inspection Trips Each Dweliing Unit �$60
( TOTAL FE j I ��� I
minimum total fee is $20
THISARFAFORINSPECTORUSEOPLY
I hereby cer6(y that I inspecOed the electrical installa6on described herein on the dafes sUted:
%�. �
5 21 Ins 'On $30 r Fbw �oi�aom��o�_�I
S 'allns 'on $.31 Mile
iIS INSTALLATIpN MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHII�
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1533594 6 �i�
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Request Dale: Rough-in Inspedion Required? Yes ❑ No Inspedion Other Than RougMn: ❑Ready Now ❑ Wiil Call
1 0— 2 0— 0 3 Vou must call the inspector when ready! Date Ready:
I ceAify fhat I am the � LICENSED CONTRACTOR ❑ CON�ANY ❑ OWNER and hereby �equest inspection of the electricxl work at:
Job Site Address (Street, BoX or Route No.) CitY Zip Code
1165 NORTON FRIDLEY
.,�,..�„��„e � r� 5 � 7 ����,
P M J CONSTRUCTI 1V � �
� a,�i� � a,�i� nearess —
XCEL ENERGY
nere� i com�any ►�e�e c«,aaaa uoe�ue ►�,�e.
WEST STAR ELECTRIC, INC. CA01936
ilinp Address iContracta, Compeny Owner Performing NstaNatbn)
6324 LAKELAN�AVE N BROOKLYN PARK MN
oF �cTwcm coar
� �
�ror t�qnasn a Power Lsnited TecMician
Licenae Numbar
55428
cs�
763 537-0807
EB-0OOO1M11 8.7. 20Q2