HomeMy WebLinkAbout06040150 Application
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Ctty of Carmell Clay Townshtp i Ai
APPLICATION FOR ELECTRICAL INSPECTIO
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NAME PHONE FAX
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CONTRACTOR '?,/? 33" -<CJ62..{ Q<t..L-.
INFORMATION: Street Address City State Zip
NAM/f4-/LQ/(f CONTACT PHONE:
APPLICANT /fq e: LA..&/t.- 3/'/ SZ3~Z<JOG.
INFORMATION: Property Owner L Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: .v - COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE: 31? !;;f!!,( - "fb32..Hb-.€
PROPERTY 441<04 11 r-<.<:LLe7- 311 SZ3 - Z.,CX; ~
OWNER
INFORMATION: STREET ADDRESS: City State Zip
/2-32- J.-..!; li. C/l..07 b/LI '-ld ~a- -:::cr-J L/ k:>3;?
STREET ADDRESS (INSPECTlON LOCATION): City . State Zip
INSPECTION /
INFORMATION: DATE OF INSPECTIONlj /j 110 y TIME OF INSPECTION~_I
. I
TYPE OF IMPROVEMENT.
Lf(! UPGRADE SERVICE: From I f:?O
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
2-00
to
DYES
if3.- NO
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
Number of NEW CIRCUITS:
32..
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of METERS:
/
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
HAT THE INFORMATION CONTAINED
RM IS C Mr AND ACCURATE.
Signature .r/ /
44e~4 H "'/ttE[@..- <lJVft)G
PRINT DATE
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permits/Forms/Electrlcal Application Apr 2006