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HomeMy WebLinkAbout04110186 Application , r G�.�OF CA� ' � / /� . �+$TiERSHrn\,. �. � o� L 1 / V ,� (�� . �° _' � C'ity of CaYmel."/Clay Totivnship '�\ F��� � :APPLICATTON FOR ELECTRICAL INSPECTIOIV � \{N\pIAN%/ 'NAME �„�„•_�.I. ,UJ<xS�i 2 ��J��`� r�+s�+✓L;PHONE'�, �,FAX -. t.�� •" S7(-2l0 . 3'Y S1c z�3(P CONTRACTOR So i �e INFORMATIUN: streetnddress city state ziP. . q�:a ;' ;- , _ ( , � , <w rN� cs r� 6 ig . .. . NAME COMALT�PHONE: APPEICANT ��.�H ' � , ...¢.. S 7/ —.Z(a 3 w . . ._,w. INFORMATION: properry Owne� Contractor � (or agent) OR Representati4e TYP.E�of{,W.ORKp, RESIDENTIQL: COMMERCIAL: -��' ' � PROPERTY�OWNERNAME(S): PHONE:i PROPERTY 5°T C�+w�sf` r,s C,�i��.�.� $ 46 - ,S"7 (C� OWNER, _ � „__ - i „INFORMAI'ION: '�£ET�ADDRESS'pNSPECTION LOfAI"40N): City. 5[5[e 21p , ., _ .. _. .. _ _. � 1 v�-r0' �''`� : �.��„ . ,.�.>� ( �� �/,�a03�' STREET ADDRESS(INSPEGTION LOGAIION)i City . 'State�, �:'Zip INSPECTION L� INFORMATION: DATE'�OF,INSPECTION: � S� TIME OF INSPECTIONi � G✓e�! d�e c .1` — ��' T.YPE OF�IMPROVEP7ENTq MOVING SERVICE FROM OVERHEAD: � �� � ' TO�UNDERGROUND? q UPGRADE"SERVICE: .F�om to Q YES!� � NU O UPGRADE PANEL BOARD(S) [AFCI BREAKERS'REQUIRED] � Num6er of NEW CIRCUITS:,�_ O ADDITION, ALTERA7ION, REMODEL, or REPQIR`TO _�. .�,.a_ AN EXISTING�ELECfRICAL,DISTRIBUION S,Y,STEM Num6eF.of'METERS:�_ � NEW METERSERVICE (i:e. Founfain in pond; TIFYTHATTHE:INFORMATION�CONTAINED 9 9 9 � new�utili�nsernce�foi naa eaightin ; Installation of N THIS FORM'IS COMPLEfE ANDACCURAl'E: �,;_ � � �� � �` . �� � �:_: _ O ROWISIGNAL, SENSOR,_MONITOR��(i.e.Traffic L'ight) s�r atu7e �� CONNECiION or RECONNECTION'S6"A;REL'OCATED; �A-Y+"1'' -�v��,i,..,.�-e-� J! -"3d-U�f ' " - .PRI� . .- DATE . . . STRUCTURE COMMENTS'or;FURTHER LOGATION CLARIFIGATION: �(Please attach man of'inspection location) I../ '•� / � / {' � J • Y�/�� Wa:IPiY :�u! /7 GC l?PbJ `�tf SI�'�9�7 a ���<' !'Y/PTP,f' %4!CDP<'7�7�Y/_ � l�CctfP�d�7��QPy1 �!'IP, s�7 /=�//I9��PI� r'Lic/i? a�li,� �/� YIFU� l --,— —�.._ 7 .r �FEES: $ 93.50 for�Commercial Inspections; $ 52.00,for R'esidentiaf Inspections S:Pertnits%Forms/Electdca6AppllcztlortOCt�2003' � � � �