P - 78086REQUEST FOR ELECTRICAL INSPECTION
1— 5 3 3- 6 7 2�0 Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li h6n Standard 31
SERVICES / POWER SUPPLIES Traffic Si n� Standard $5
0 to 400 Amcere � S ). Sunnlnmwnlal Faa (nl A9(1
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li h6n Retrofit $.25 er Fixture
Center Pivot Irtiaation Boom � E40 �► �� .� __
Transformer I Power Su I for 5i ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All $�j . 5
Circuits and Two Inspec6on Trips Each Dwelling Unit @ y80
Addi6onal Ins tion Tri s $20
Investi ative Fee
Reins tion Fee $20
TOTAL FEE
�` (minimum total fee is $20) 8 5. 5 0
iH15 MEA FIXt INSPECiqt USE OIlY
I hereby certify that I inspected the elettric� insfallation deuribed herein on the dates stated:
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S ial Ins Gon S•31 r Mile
� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Request Date: Roughin Inspection Required? es ❑ No Inspedion Other Than Rough-In: �Ready Now ❑ Wfll Call
1-12-04 You must call the inspecta when ready! Date Ready:
I certiy that I am the UCENSED CONTRACTOR � COMPANY ❑ OWNER and hereby request inspec6on of the electrical work at:
Job Site Address (St Box. a Route No.) City 7�p �e
1219 NOR'I�ON AVE �IDr,Fv
P M J CONSTRUCTION � � �
Power Supplier Power Supplier Address
XCEL ENERGY
Contracta / Company Name Contractor License Number
WEST STAR ELECTRIC, INC. CA01936
Mailing Address (Contrada, Company or Owner Perfortning Installation)
6324 LAKELAND�A� N BROOKLYN PARK MN
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License Number
55428
763 537-0807
EB•OOOOfM1/ 8.1.2002