HomeMy WebLinkAbout06060171 Application
CONTRACTOR
INFORMATION: -""......
mEET A.ODRESS (INSPECTlDN LOCATlON)~ Cltv Stau!
/:)77 Un~-r /#,,(. <;.;t;i../.-vl ~c//"N"f"L'.. :C"OL - 14ii J ';:,-
STl\EET ~OORES$ (IN!il'EcnON LOCATION), ;;>? ~, CIty Stm
INSPECTION .f!//j- 1''- jo!, t:Y- ~..LJ;t C. tIJ",,,,,~L 'Z'",;!".,.-
INFORMATION:
DATE OF INSPECTION: (; ~.6 :;, TIME OF INSPECTION: ,;:t{1F,,,,,:~c'/
I;' ~J' ,N,-J 7/~t)
TYPE OF IMPROVEMENT: MOVING SERVICE FROM OVERHEAD
10 UNDERGROUND?
o UPGRADE SERVICE: From
APPUCANT
INFORMATION:
TYPE of WORK,
PROPERTY
OWNER
INFORMATION:
13173819892
RAND T TRENCHING
PAGE 01
City of Cannell Clay Township ,
APPLICATION FOR ELECTRICAL INSPECTION
~ffD~Of.aOI7/
N~ME
n 1; '&tL--C-t/IC--
PHONE
fA)(
S,.re
1,'J3bf e', SiJ<.Lli('lJdl',!,'J,A'v~ .-rd~,~-", L,s ..-f,~d- 6Z""C;
N.\Mf CONTACT PHONE:
,c;.bPv1'"
Property Owner
(or agent)
C. o',7r
~
OR
Contractor
Representative
RESIDENTIAL:
COMMEROAL:
PHONE: ( J i7 ) ;? -: 5'.<( 1'1-;3
Lce. /i,6t,,-
PROPERTY OWNER NAME{S):
S i3 C.-
Zip
lip
to
o yeS
o NO
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
Number of NEW CIRCUITS:
NumberofMETERS:~
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS ORM IS COMPLETE AN CCURATE.
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTlUBUION SYSTEM <
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or slgnage lighting; Installation of
new utility services for an area)
/7
L,- .
o
~
ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Ught)
CONNEcnON or RECONNEcnON TO A RELOCATED
STRUCTURE
C;,1..6...1"
PRINT
(. j?,lr
(.; /~t1//.J~
-b"TE /
FEES: .$ .
for Commercial Inspections; $ ~for Residential Inspections
>!J
S:Po""IIs/Fom1s/EIectrlcaI Aoi>lt"t/O'l ~ 2001