HomeMy WebLinkAbout06040067 Application
CONTRACTOR
INFORMATION:
1; IE:d-rtL
Oty
t;. 5~
FAX
NAME
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Street Address
Stale
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g
NAME
70R-TRit IT \to
Property Owner \/
(or agent) -A-
RESIDENllAL: ~
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APPUCANT
INFORMATION:
OR
Contractor . \
Representati/le
TYPE of WORK:
COMMERGAL:
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
'RRTAAIT
PHONE:
STREET ADDRESS:
Oty
3\
ls.
- 0 S - <gq
$tate Zip
IN 4~dloO
\ ~ 41007
State
Zip
INSPECTION
INFORMATION:
City
ZIDn5V\ \\e..
DATE OF INSPECTION:
TIME OF INSPECTION:
o UPGRADE SERVICE: From to
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUN~? /
DYES ^NO
Number of NEW CIRCUITS: I
TYPE OF IMPROVEMENT:
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
izl NEW METER SERVICE (i.e. Fountain in pond;
/ . Subdivision street or signage lighting; Installation of
new utility services for an area)
Number of METERS:
\
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
c
n
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (P
&1 . ('n 5
31CaO If
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/FonnslElectr1cal Appllcatton Apr 2006