P - 78395- REQUEST FOR ELECTRICAL INSPECTION
, 1- 4 6�- 4 2 0� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800TTY/MRS1-800-627-3529 www.electricity.state.mn.us
�NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy 'rf necessary - the work covered by this request:
4—PLE �^—�--_.
GENERAL FEES Outdoor Li h6n Standard b1
S VICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re $25 d Su lemental Fee $20
401 to 800 Amcere (� SS Transfnrmeis un M 10 KVA !nl A10
�, COMMUNICATION, REMOTE CONTROL, SIGNALING
ITS, CIRCUITS OF LESS THAN 50 VOLTS
ach System Device or Apparatus @$.50
ADDITIONS TO THE GENER,4L FEES
FAMILY DWELLINGS PER UNIT
to 12 Units p$50 Per Unit
fit � $.25 per Fixture
rigation 800m � S4C
Home Park Lots � S
IIII II III II III fl II I 11 III li III II III II I II ��I I Iiil
14684203
Rw�� ��+�d� Rough�n Inspection Required? Yes
8- 21- 0 3 You must call the inspedor wh reedy!
I certify that I am ihe LICENSED CONTRACTOR ❑ COMPAN
Job Site Address (Street, Box, or Route No.) cny
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
TOTAL FEE
(minimum total fee is $20) $ 5. 5 0
THIS APEA FOR INSPECTpi USE plY
I hereby certify that I inspected the electric� insWla6on des�xibed herein on the daAes sf�ed:
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] No Inspection Other Than Rough-In: OReady Now 0 WIII Call
Date Ready:
❑ OWNER and hereby request inspection of the electrical work at:
1275 NORTON AVE NE FRIDLEY
P M J HOMES
west star electric, inc.
Aaling Address (Contractor, Company or pwner Performing Insfalla
6 3 2 4 LAKELA�TD AVE N BRa
YELLOW � gpqRp pF
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..anna«ar ucense numoer nnaster tiecmpan or r�ower umrteo Tecnnician
��k�8$ CA01 ��'� N"m�r
YN PARK MN 55428
i) Fr,one (s)
763 537-0807
fRICITV�Y --. E&00001A-74 8.1.2002