HomeMy WebLinkAbout06070127 Application
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City of Cannell Clay Township ,I
APPLICATION FOR ELECTRICAL INSPECTION
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CONTRACTOR
INFORMATION:
NAME
s', 11".\
PHONE
Cons:tf'Uct;,.h' J-nC JJ7.S'i'l.(JILU
City State
.?olr ," [jc;Cf"U2;
Street Address
5(0],9 (J. U.S
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APPLICANT
INFORMATION:
NAME
;ll; J1C' L \ ,A..t C r; \1., c.
Property Owner
(or agent)
TYPE of WORK:
, 'RESIDENTIAL:'
PROPERTY
OWNER
INFORMATION:
PROPERlY OWNER NAME(S):
C 1 e. \ C\ ('AC S j\O<)\ ~
STREET ADDRESS:
c::-, s+ s+
--=-,:,zOI E. I.:;, -.
STREET ADDRESS (INSPEcnON LOCATION):
INSPECTION
INFORMATION:
horae RJ
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~ NEW 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 RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
'?/(W ShFI' + a 41Ck)
FAX
Zip
-:rrJ
'-Ice 1210
CONTACf PHONE:
OR
21 . WZ({ -CilL.o
Contractor
Representative '/.-
COMMERCIAL: :' ,
PHONE:
lcN ~ - 9%; /
City
Zip
, I,.
'/(O(lS _~
State
C7r c:
City
TN
State
Zip
rlV
TIME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
o NO
Number of NEW CIRCUITS: ~
I
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM ISfOMPLETE AND ACCURATE.
711 ~c-C\-o~J--m ~J},,- '-'-. .
Slgnature
M ;GI~1 C6-hcc 7-2~-{)G
PRINT DATE I
(Please attach maD of insDection lo~atiOn)
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,
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permits/Forms/Electrlcal Application Api 2006