HomeMy WebLinkAbout06060198 Application
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City ofCarmellClay Township . 1/#'p:e~P
APPLICATION FOR. ELp~;rRICAL INSPECTifON
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NAME
PHONE
CONTRACTOR
INFORMATION:
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City
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State
Zip
Street Address
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APPLICANT
INFORMATION:
NAME
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Property Owner
(or agent)
CONTACT PHONE:
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OR
Contractor .
Representative X
TYPE of WORK:
. . RESIDENTIAL:
. COMMERCIAL~. X...
PROPERTY OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:
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STllEET AD
CIty State Zip
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CIty State Zip
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STllEET ADDRESS (INSPEcnON LOCATION):
INSPECTION S lj -'6'-1 E I '-Co tl-....
INFORMATION:
DATE OF INSPECTION:
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
~ UPGRADE SERVICE: From <.010 to ~ 100
o UPGRADE PANEL BOARD(S)
DYES
~ NO
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
o 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 FORM IS COMPLETE AND ACCURATE.
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Signature "
o ROW SIGNAL, SENSOR, MONITOR (Le. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
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PRINT
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DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/FonnS/Electrlcal Application Apr 2006