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P - 78101REQUEST FOR ELECTRICAL INSPECTION 1 � � Q •� � � (� � � Minnesota Board of Electriciiy ^ - V� � �, 1821 University Avenue Suite $-128, Saint Paul, Minnesota 55104 (651) 642-08Q0 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us EW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the bxk of ihe white copy 'rf necessary - the work covered by this request: NEW HOME GENERAL FEES Outdoor Li htin Standard $t SERVICES I POWER SUPPLIES _ , Traffic Siqnal Standard Cd 55 I 401 to 600 Ampere @ 350 � Above 800 Ampere . 575 CIRCUITS / FEEDERS 0 to 200 Ampere � $5 Above 200 Ampere �$10 ALARM, COMMUNICATION, REMOTE CONTROI CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each System Device or Apparatus @$.50 ADDITIONS TO THE GENERAL I MULTIFAMILY DWELLINGS PER UNIT 3 to 12 Units @$50 Per Unit Exh Additional Unit @ $25 OTHER ADDITIONAL FEES Li hGn Rehofit $.25 er Fixture � Center Pivot Irri ation Boom $40 t Manufactured Home Park Lots $25 Recreational Vehicle Park Sites $5 Se arate Bondin Ins tion $20 Special Inspection p$30 cer Hour ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service andlor Power Supply up to 500 Amperes, All Circuits and Txro Inspection Trips Each Dwelling Unit @$80 TOTALFEE (minimum total fee is $20) 8 5. 5 0 iH15 MEA FOR �NSPECTIX2 USE Of1Y I hereby cerfiy Mat I inspected the electric� insfalla6on described herein on the dates stated: s+�-�- i x c 3__�j - c� A«,� �N o�,E l_ /1 f w�.a� _ INSTALLATION MAY BE ORDERED DISCONNECTED IF I �II II I!i II Iil !I III II II! II !'I II III I I III � I I� 15822927 � 30��� ��%� � 5`�� Request Date: Rpugh-in Inspection Required? es ❑ No Inspection Other Than Rough-In: ❑Ready Now ❑ MGII Call 2— 4— 0 4 You must call the inspector when ready! Date Ready: I certify ihat I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at:: Job Site Address (St Box, or Route No.) Ciry Zip Code 1217 NORTON AVE FRIDLEY P M J HOMES � U t��` er Supplier Power Supplier Addre XCEL ENERGY ractar / Campany Name WEST STAR ELECTRIC, INC. ng Address (Contractor, Company or Owner Perfortning Installation) f���� 6324 LAKELAND AVE N a � � � � ma.+ier oecviaan or rrower umrtea rethnid� CAO 1 9 3 6 Ucense Number BROOKLYN PARK MN 55428 Fn«,e (s) 763-537-0807 eo�rt� oF e�crnicm coar