P - 78066REQUEST FOR ELECTRICAL INSPECTION
L.� - 5 3 3- 5 9�� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saiirt Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
�IEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back M the white copy if necessary - the worlc covered by this request:
GENERAL FEES Outdoor Li9htinu Standard (a? $1
0 to 400 Ai
401 to 800
Above B00
� Above 200 Ampere �510 " � I
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aralus $.50
ADDITIONS TO THE GENERAL FEES
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlw Power Supply up to 500 Amperes, All $ 5
Circuits and Two Inspection Trips Each Dwelling Unit �$80
fIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units @$50 Per Unit (minimum total fee is $20) 8 5. 5 0
EeCh Additi0�21 U�il @$25 ���s �� Fa+wsa�cran use «ar
I hereby ceNfy Ihal l inspec0ed the elec6ical insfaalla6on described herein on the dates sta0ed:
OTHER ADDITIONAL FEES
Li htin Retrofit $.25 r Fixture
Center Pivot Irri ation Boom $40 R01G1iN °AiE
Manufactured Home Park Lots $25 %`..3 J
R¢CfP.2hOf121 VBhiCl2 P�k S1�CS s5 Fn+u ra�craw wre
arate Bondin Ins tion S20 �- �l
S ial Ins Gon 330 r Hour E'wn�oinavoor� onrE
S iallns 6on Z.31 Mile
S INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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15335987
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Request Date. Rough-in Inspection Required? L�'es U No Inspection O[her Than RougMn: �Ready Now � YYfll Call
10 — 21 — 0 3 You must call the inspecla when ready! Date Ready:
I cefiry that I am the LICENSED CONTRACTOR ❑ COA�ANY 0 OWNER and hereby request inspection of the electrical work at:
Job Site Address (Street, Box. or Raute No.) City 7� Cade
1173 NORTON AVE FRIDLEY
P M J CONSTRUCTION
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WEST STAR ELECTRIC, INC. CA01936 v°�"�Ninnnbef
�iling Address (Contrada. Campeny a Ovmer Perfortning InstaNation)
6324 LAKELA VE N BROOKLYN PARK MN 55428
sigr�adxe ccoMra r or owner Perrortn«,g �nstenahon> F►,one (s)
763 537-0807
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