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HomeMy WebLinkAbout06050103 Application -'."-,', ;'- J>','"., j' ',' . , .. -I L tb. ( I CI City ofCarme1/Clay.:ToWfij~!p ... . .'-.)8T 2 ~.(jLT~?L J. ..,.,. _,,;,,"'.. , APPLICATION FOR ELF;CTRICAL INSPECTION ~ {A 00"0 ()3 NAME PHONE FAX CONTRACTOR INFORMATION: Street Address ~ '/ City State Zlp 193 ~ 02- NAME CONTACT PHONE: APPLICANT INFORMATION: OR Contractor Representative J 973 TYPE of WORK: RESIDENTIAL: V' COMMERCIAL: PROPERlY OWNER NAME(S): PHONE: r 2-/~5 1t.f;2- :111/ PROPERTY OWNER INFORMATION: S' Cq,r;n, City State ZIp STREET ADDRESS (INSPEcnON LOCATION): CIty State Zip INSPECTION .s- '7 iJ W 10 INFORMATION: DATE OF INSPECITON: TYPE OF IMPROVEMENT: MOVING SERVICE FROM OVERHEAD TO UNDERGROUND? o UPGRADE SERVICE: From to DYES o NO o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED] Number of NEW CIRCUITS: /f Number of METERS: 2... I CERTIFY THAT THE INFORMATION CONTAINED ON THIS FORM IS COMPLETE AND ACCURATE. # f~ r~/-jltf:;? ,},n4Aa<r/ 7}//{,/Oh PRINT / DAllI; o ADDmON, ALTERATION, REMODEL, or REPAIR TO AN EXISTING ELECTRICAL DISTRIBUION SYSTEM ~EW METER SERVICE (i.e. Fountain in pond; 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 RECONNECITON TO A RELOCATED STRUCTURE COMMENTS or ~RTHER LOCATION CLARIFICATION:.5PI~ase attach maD of insDection location) M~'(~r ~a{~7'7/ /oc/;tf~q'It/~6?'/:l;;J/'/t/-f' . . . T ,";' ,\.:::'/i:r~~;;.:~:/::.,(.i,. ~.,.:;. . ,.j;' >E:i., .', .';;. ;;.,:"'.:,' ,,' FEES: ,'.. .:,' ":. -- ' "~"',',.j/' ~':~ ': . - ._': >, . , .. ,. ........\,.,' '1. $ 93.50 for Commercial In~pe~i,p~~t;l~~~()O forResidel1.t!~1 Inspe;Ctlons . ., ,.'. ..--,"',' ,'-- -'-- " . S3/!i'o S:PermIts/FormS/Electrlcal Application Oct 2003