HomeMy WebLinkAbout06040130 Application
, , ~ . City of Carmell Clay Township q'/ 06fJ'ltJ /:3 ()
\~I .' ~) APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
FAX
CONTRACTOR
INFORMATION: Street Address
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NAME
State
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COi'lTACT PHONE:
APPLICANT
INFORMATION:
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OR
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Contractor
Representative
Property Owner
(or agent)
TYPE of WORK:
RESIDENTIAL:
COMMERGAL:
PROPERTY OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:
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STREET ADDRESS (INSPECTION LOCATION):
State
Zip
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STREET ADDRESS (INSPECTION LOCATION):
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State
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Zip
INSPECTION
INFORMATION:
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TIME OF INSPECTION:
-----.
TYPE OF IMPROVEMENT:
OVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
o NO
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
/ AN EXISTING ELECTRlCAL DISTRIBUION SYSTEM
Y NEW METER SERVICE (J.e. Fountain in pond;
Subdivision street or signage lighting; Instaliation of
new utliity services for an area)
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPL~;RATE.
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Signature
o ROW SIGNAL, SENSOR, MONITOR (i,e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
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PRli'lT
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COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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FEES: $ or Commercial Inspections; $ 53.50 for Residential Inspections
S:Permlts/FormS/Electr1Cal Appltc~tlon Oct 2.003