P - 78100REQUEST FOR ELECTRICAL INSPECTION -
1� C, �. �.� �(� �� Minnesota Board of Electricity -
'✓ � 1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-OB00 T1Y/MRS 1-800�27-3529 www.electriciry.state.mn.us
W❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
NEW HOME
GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Traftc Si nal Standard S5
0 to 400 Am re $25 Su lemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer I Power Su I for Si ns / OuUine Li htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes tne Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Txro Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A ratus $.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Addifional Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofit $.25 er Fi#ure
Center Pivot Irtiaation Boom fa� S40
TOTAL FEE 8 r, . Jr
(minimum totai fee is $20)
iM15 AREA FIX2INSPECiIX3 USE IXYY
I hereby certify that I inspected the electrical installa6on described herein on the dates sfated:
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5 181 I�S 100 $30 f HOUf exPir�onsuoowEO — — oare
S ial Ins tion $.31 r Mile
� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Request Date: Rough-in Inspection Required? Yes ❑ No Inspection Other Than Rough-In: ❑Ready Now � Will Call
2— 2— � 4 You must call the inspector when ready! Date Read .
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I certify that I am the LICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the elecfical work at:
Job Site Address (St . Box, ar Route No.) City Zp �e
1215 NORTON AVE FRIDLEY
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Power SupP�� Power Supplier Address
XCEL ENERGY
Contractor / Company Name ConVactor License Number Master Electridan or Power Limite
WEST STAR ELECTRIC, INC. CA01936 u�s�nu'm�
Mailing Address (Contracta, Company or Owner Performing InstallaGon)
24 LAKELA D AVE N BROOKLYN PARK MN 5542
$ipnature (Cont or pany or Owner pertpmiing Ins1a11aGon) Phone (s)
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IN8 C OP COPY BOARp OF ELECTRICIIY COPY EB-00001M