P - 78394REQUEST FOR ELECTRICAL INSPECTION
.� - 4 6 8- 4 21 � Minnesota Board of ElecUicity
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651)642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
�IEW ❑ REMODEL 0 ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
GENERAL FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES >, Traffic Sianal Standard �$5
A, COMMUNICATION, REMOTE CONTROL, SIGNALING
ITS, CIRCUITS OF LESS THAN 50 VOLTS
�h System Device or Apparatus � $.50
ADDITIONS TO THE GENERAL FEES
FAMILY DWELLINGS PER UNI
to 12 Units � E50 Per Unit
ach Additional Unit � $25 �
Center Pivot
Hour
Transformers
Includes the Service �dlor Powe� Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$Bp
TOTALFEE
(minimum total fee is $20) 8 5. 5 0
TIpS MEA Fpi RbPECidi 1AE p1Y
I hereby cer6fy that I inspected Ihe electrical insfall�on described herein on the dates sf�ed:
7
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF
I IIII II III II III II III II III II II) II III ll lll �� I�I
1 4 6 8 4 2 L L
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�9� �e: Rarghin Inspection Required? L�Yes 0 No Inspection Other Than RougMn: �Ready Now ❑ W� CaU
8— 21 — 0 3 You must call the inspector when re�ady! �� R�e�,:
I cerrtify that I am ttie ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER ar� heieby request inspection of the elactrical work at:
Job Site Address (Sireet. Box, a Roule No.)
1277 NORTON AVE NE
P M J HOMES
FRIDLEY
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••� ��vd �r �•����� wnvaaar �xense nunoer �ter tieanaan a Power ummea 7edr�eian
WEST STAR ELECTRIC, INC. CA01936 u`�""'"�`
ahn9 Ad� (Contracta, Company or Owner Perfammg Mstalla6on)
6324 LAKEL ND AVE N BROOKLYN PARK MN 55428
Si�neture ( . compsny or ow�er Perr«ming �nsmnanon) Pn«,e (s)
,
763-537-0807
$ . eo�wo oF e�clwcm coar �omou-�� e.�. zaa¢