P - 78068-- �„
[ REQUEST FOR ELECTRICAL INSPECTION
1� J'3 3- 5 9 6� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
. . (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
}�dEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
GENERAL FEES Outdoor Li htin St�dard $1
SERVICES I POWER SUPPLIES Traific Si nal Slandard $5
0 to 400 Am re $25 Su lementai Fee $20
401 to 800 Am re 350 Trarisformers u to t0 KVA $10
Above 8(!0 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS %�'7 Transinrtnnr / Prwrwr Sunniv fnr Sinnc � n��+��„o i��titi�„ n Qc
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus � 5.50
550 Per Unit
Unit @ $25
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes lhe Service andlor Power Supply up to 500 Amperes, All $ rj
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FEE
(minimum total fee is $20) 8 5. 5 0
iM15 MEA GOR INSPECipt USE ONLY
I hereby ceAify that I inspected the ek�cfical insWlation deuribed herein on the dates stated:
Manufactured Home Park Lots 525 .—��'—'---� d S j
Recreafional Vehicle Park Sites $5 F'"^� "'��CTON o�re
Se arate Bondin Ins 6on $20
S iallns on $30 rFbur Eza�a�oina,roor�o pq,
S ial Ins tion $.31 r Mile
_ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETEO WITHIN 12 MONTHS
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Request Date: Rough-in Inspection Required? es ❑ No Inspedion Other Than Rough-In: ❑Ready Now ❑ Will Call
1 0— 21 — 0 3 YOU must call the inspector when ready! Date Ready:
I certify that I am the �'LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Jab Site Address (Street, Box, a Route No.) City 7�p �e
1169 NORTON AVE FRIDLEY
_....�._�_.-. .A. _ ♦ noexrtovia
P M J CONSTRUCTION 1 ��
Power Supplier Po�r Supplia Address
XCEL ENERGY
Contrador / Company Name ConVador License Number
WEST STAR ELECTRIC, INC. CA01936
Mailirg Address (Contraqpr, Company w Owner Perfonning Installation)
6324 LAKELAND AVE/N BROOKLYN PARK MN
ON BAGK OF YELLO�GOPY .E- e�p CTRICITV GOPY
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License Number
55428
ts�
'�63 537-0807
EB-00001M74 8.1.2002
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