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HomeMy WebLinkAbout14050179 Application �\t oFCqq�.\ Permit'# . �' �'�'��79 /-�' .¢r r,rs2�� . �'r ;; �City of CaYmel/Clay �Township ' '°"'°°":``" ,� APPLICATION�FOR ELECTRI"G�AL IN;SPECTION ., . .� __ � , �>"-/NDI:PNP:� � " NAME PHONE � FA% GONTRAGTOR_ :�` - INEORMATION': so-eecnadress ciry stafe, iiP � 'NAME CONTACTPHONE: APPLIGANT D!*!N'7s' � INFORMATIONc ;property Ownec Contractor (or-agent)' � QR' Representative TYPE of WORK: $ESIDENTIAL':;� COMMERCIAL:: � PROPERT,1`�OWNER'NAME(S)': PHONE: j/.T) 57�7-= 038�_t� PROFERTX ` � C:DND!/lsl2 ,; , UWNER . � -° -^� SiREETADDRE55.^ �.Gity State Zip INF,ORMATIQN: -- .. y�z Asy D,� �,��� r,� y�� SIREETADDRE55(MSPEGT[ON:LOCAl10N): Ciry 'State Zlp: � INSPECTION �6(j ,ASN .D/Z �/�✓YJ�' :" rN y6lT.3 . ,._, INFORMATION: _ DAT,E�qF INSpECI°IgN; i �"TIME OF INSPECTION: P�Q+�yu�,_ - , . • TYPE OF IMPROV,EMENT: � ' � ' � • ,�, , ,.._ • . � "_ � r '. , Number of NEW CIRCUITS: � -, . UPGRADE SERVICE>� From ./G�J 'to 201� �. - Numtier of METERS: � ;�" UPGRADE PANEL BOARD(S) ❑ .ADDITION, ACTERQTION, REMODEL,.or REPAIR�TO AN EXISTING:ELECTRICAC'DISTRIBUION SYSTEM ' ` (i.e. Founfain in pond; I CERTIFY THAT'T INFORMATION CONTAINED ❑ NEW MEfER SERVICE Subdroision sfreet or sigpage lighting;•Installation;;of ON THIS FO PL`E7E!AN ` URATE. new utility3services foran area) `�. - O ROW SIGNAL� SENSOR,,MONITOR.(� e. Tra�C Liglit) �-s�9nature O ,CONNEGTION;or RECONNECLION TO A RE�OCATED L�T/'�Gr� ��ya��`,� �S/z$�'� � STRUCTIJRE. 1PRINT oATE COMMENTS';or,FURTHER LOCATION CI.ARIF.ICATION: (Please+attach map of'in§pection location) ���7� FEES:, $ 1�19.00 f'or Commercial'Inspections; $'"65.50;for Residentiaf Inspeetiona i5i\Permi[s\FORMS\Att�ve Forms�,Blnder,(COpyable�,Form Or'gln'als)\APP�i[atlons\2074'Elec[�Ital Inspec[ion Applica[lon:doc