P - 78393REQUEST FOR ELECTRICAL INSPECTION
�� 4 6 8- 418 � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800TTY/MRS 1-800-627-3529 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:
$� 4—PLEX
GENERAL FEES Outdoor Liahtina Standard CaD $1
SERVICES I POWER SUPPLIES
0 to 400 Am ere $25
401 to 800 Am ere S50
Above 800 Am e E75
CIRCUITS I FEEDERS
0 to 200 Am e$5
Above 200 Am e $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device w Apparatus @$.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unft
Each Additional Unft � $25
OTHER ADDITIONAL FEES
Lighting Retrofit � E.25 per Fixture
Center Pivot Irriaation Boom � S40
II� II III II III II III II III II III IIIII II III a�l I�
1 4 6 8 4 1 8 7
Includes the Service andlw Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Investi ative Fee
Reins tion Fce $20
TOTAL FEE $ rJ . r, �
(minimum total fee is $20)
rHR nnEn iart RaFECTOn u5E aar
I hereby cerdry th& I inspecBed the electrical i�fallation deuribed herein on Me da�es sfa�d:
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eceques[ ua[e: Rough-in Inspeetion Required? Yes LJ No Irupedion Other Than Rough-In: ❑Reedy Now 0 Will Caq
8— 21 — 0 3 You must call the inspeator wh .�ari Date Ready.
I certiy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of Uie electrical work at:
�� s�ce naa� � eox, a ra�,oe rb.� cny z� coae
1279 NO TON AVE NE FRIDLEY
I1' M J HOMES
� � � �
WEST STAR ELECTRIC, INC. CA01936 ��"�"""'�`
Mairng naaBgs (contractar, comva�y a owner Perr«ming r�stal�an�
6324 LAKELA AVE N BROOKLYN PARK MN 55428
nature ( a Owner Perfaming Instellatbn) Phone (s)
_ 763 537-0807
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