HomeMy WebLinkAbout06060184 Application
City of Carmell Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
FAX
CONTRACTOR
INFORMATION:
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7"10 - 0 ;:;.5'
City
Street Address
State
APPLICANT
INFORMATION: Property Owner
(or agent)
.c.oNsv.rdl
CONTACT PHONE:
OR
Contractor , /
Representative --1L--
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TYPE of.WORK:- .- -~". RESlElENTIAL:--..'.,-
PROPERTY OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:'
I}J
S"ntEEf ADDRESS:
City
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State
STREET ADDRESS (INSPECTION LOCATION):
City
State
INSPECTION
INFORMATION:
DATE OF INSPECTION:
R.fVld :iN
TIME OFINSPECTION:
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
o NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS: I I
Number of METERS: I
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
y1
NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
.
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FO IS CaMp. ETE AND ACC TE;
-.-
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
Signature
o CONNECTION or RECONNECTION TO A RELOC~TED
STRUCTURE
ffCIlA/(7) M {;f:;f If; -B-oC:.
PRINT DATE
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COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
€! IN;;;:,e~ec1Iol\J c>F k'LfN~EJUS'MJ.7lf XLVI) / ~e.RV fft:e
R/ Be !(iN]) /?ock. fJU/J;e. II)?X--; 70 Po,l/D. I .
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:PermJtsjForms/ElectricaJ Appllcatlon Apr 2006