HomeMy WebLinkAbout06020141 Application
FEB-21-2006 rUE 05:09 PM
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FAX NO.
P. 01
City of Cannel/Clay Township 0 GOd- () /11
APPLICATION FOR ELECTRICAL INSPECTION
NAME P~DNE
Wu.lh.,- t S'D'~S Co"sfrwc!,b"lJ /"'<:.,
'7roo:;- s><.-/,fY
w.J~,-S,.-1[f7</
CONTRACTOR
INFORMATION:
Street AdQreSS
~(.bo '>b,,,iPJ 1'1/ s,+,
r, (), 3.", S'>
N,.,Mf
Q:)~ Wrclle.-
APPUCANT
INFORMATION:
Property Owner
(or agent)
TYPE of WORK:
RESIDENTIAL:
C~
I:: I wuc<P
Stm
Zip
'I(,(~U.
IN
CONTACT PtlON'f:
~(7- 401- ;}..~<ol
OR
Contractor V
Representative .6.-
COMMEROAL: )(
PROPERTY
OWNER
INFORMATION:
PROPERT'I OWNER HAMEl'):
~IQ 1Gi)J,^~~:
PtiONE:
Ib,\o.l W"-'i.f~ 7)1~+ri,-+
Ci\v
$/1- f-</<f- 9;).00
STRf J-DDRESS:
INSPECTION
INFORMATION:
'RJJ,
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~ NEW METER SERVICE (i,e. Fountain in ponel;
Subdivision street or signage lighting; Installation of
new utility services for an area)
o ROW SIGNAL, SENSOR, MONITOR (i,e, Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
Stolte Zip
/ JJ . ()l-fO
Stlte Zip
INlIr),(\4 ~IIS /,J ,/{,7-'1~/()33
TIME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o YES
e NO
Number of NEW CIRCUITS: /
.
Number of METERS: J
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE,
1f~e(1 f! iAd6/'- tfO?;t,G /
Slgnat\lf"e
1?t~<r+ f, wc,lkr- ;l.-:tl-Ob
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (pleaSe attach maD of InsDection '...."'tion)
NQ(,,) f/~fi,-, 'S'trVI'-"- ('<:'. Ntw f'^""P S+V+/bVl lo<:.oJeJ. o.l/)"'_~ 5'or "'J mit!
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1(e,o-J (€C.",+ Sldt) /U.S+ "",'t\., .,f %#1 Sf,
, I
FEES: $ 96.25 for Commercial Inspections; $ 53.50 for Residential Inspections
S~PaTnlts1FormSlElectr1l;oi1l ApplIcation Oc;t 2003
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