P - 78392,
REQUEST FOR ELECTRICAL INSPECTION
1�`-F U�- 419 5� Minnesota Board of Electricity -
.s 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-08Q0 TlY/MRS 1-800-627-3529 www.electricity.state.mn.us
EW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
4—PLEX
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Apparatus @ $.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Unils @$50 Per Unft
Each Additional Unit @ $25
( I�II II III II II� (I (II II III �I I� II III II III I) ����)
14684195
Trafic Si nal Standard �$5
Su lemental Fee $20
Transfortners u to 10 KVA $10
Transformers over 10 KVA $ 20
Transtormer I Power Su for Si ns I Outline L' htin SS
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Senice andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$60
Reins tion Fee $20
TOTALFEE
(minimum total fee is $20) 8 5. 5 0
iM15 PRFA Fqt INSPECiOR USE 0ldY
I hereby certify that I inspected the elecbic� installa6on described herein on the dates sf�ed:
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Request Date: Rough-in Inspection Required? �p Yes LJ Pb Inspedion Other Than Rough-In: ❑Ready Now � VWI Cali
8- 21 - 0 3 You must call the inspector when ready! Date Ready:
I certify that � am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request mspection of the electrical wak at:
Job Site Address (St � Box� or Route No.) City Zip Code
1281 NORTON AVE NE FRIDLEY
P M J HOMES
WEST STAR ELECTRIC
Mailing Address (CoMractor� ComPany Owner Peri
63?� L.�KELA�T�VE N
BOARD OF ELECTRICITV COPY
� � � �
ise Number Mast� Electrician a Power Limited Tedviidan
Li�nse Number
�36
�RK
Phone (s)
763 537-0807
EB-0OOOfA-14 8.1.2002