HomeMy WebLinkAbout06050103 Application
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APPLICATION FOR ELF;CTRICAL INSPECTION
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NAME
PHONE
FAX
CONTRACTOR
INFORMATION: Street Address
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City
State
Zlp
193
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02-
NAME
CONTACT PHONE:
APPLICANT
INFORMATION:
OR
Contractor
Representative
J
973
TYPE of WORK:
RESIDENTIAL:
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COMMERCIAL:
PROPERlY OWNER NAME(S):
PHONE:
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: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.
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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)
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FEES:
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$ 93.50 for Commercial In~pe~i,p~~t;l~~~()O forResidel1.t!~1 Inspe;Ctlons
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S:PermIts/FormS/Electrlcal Application Oct 2003