HomeMy WebLinkAbout06070111 Application
City of Carmell Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
CONTRACTOR
INFORMATION:
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Oly
Slate
Zip
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CONTACf PHONE:
APPLICANT
INFORMATION: Property Owner
(Dr agent)
..317-- sz-
OR
Contractor
Representative
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TYPE of WORK: RESIDENTIAL:
COMMERaAL:
PROPERlY OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:
30
~";.
Av;
.31
aty state Zip
4~z{cr
Oly Slate Zip
r'ST
STREET
STREET ADDRESS (INSPECTION LOCATION):
INSPECTION
INFORMATION:
TIME OF INSPECTION:
o UPGRADE SERVICE: From
to
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
tsl'NO
DYES
TYPE OF IMPROVEMENT:
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
Number of NEW CIRCUITS:
Number of METERS: .:L
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE '.
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PRII'IT
1- /zofi 0
, DATi
COMMENTS or FURTHER LOCATION CLARIFI
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TION: (Please attach maD of insDection location)
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FEES: $ 100.00 for Commerciallnspectionsi $ 55.50 for Residential Inspections
S:Permlts/FormstElectrlcal Application Apr 2006