HomeMy WebLinkAbout06060100 Application
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City of Cannel/Clay Township
APPLICATION FORELECTRlCAL INSPECTION
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PHONE
FAX
I CONTRACTOR: '
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APPLICANT:
Street Address
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MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
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COMMERClAL:
TYPE Df WORK:
, RESIDENTIAL:
ST1lEET ADORESS of INSPECTION LOCATION:
INSPECTION
INFORMATION
TIME OF INSPEcnON:
\ O'?)ciD
() = 30
SE A TrACH A MAP OF INSPECTION LOCA TION
TYPE OF IMPROVEMENT:
~ UPGRADE SERVICE: From ) Q() to ~C)()
o UPGRADE PANEL BOARD(S)[AFCI BREAKERS REQUIRED]
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRlCAL DISTRlBUION SYSTEM
DYES
~ NO
Number of NEW CIRCUITS:
Number of ~ETERS: \
o NEW METER SERVICE (I,e, fountain In Pond;
Subdivision street or slgnage lighting; fnstallatlon of
new utility services !'or an area)
I CERTIFY THAT THE INFORMATION CONTAlNED .l
ON THIS FORM IS CO~LETE D A~RATE, I
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Sl9n'.ture i
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o ROW SIGNAL, SENSOR, MONITOR (I.e, Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
I FeES: $~or Commercial Inspections; $ ~or Residential Inspections
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S:Ptl1mla/FormS/ElflCtrlc:.11 AppllcadM2003