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:
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INSTALLATION MAY BE ORDERED DISCONNECTED IF I
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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
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ma.+ier oecviaan or rrower umrtea rethnid�
CAO 1 9 3 6 Ucense Number
BROOKLYN PARK MN 55428
Fn«,e (s)
763-537-0807
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