HomeMy WebLinkAbout06070113 Application
City of Carmell Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
0//3
NAME
~,..-/-
PHONE
FAX
3{ ~'l' s-
state Zip
IAI
8
Contractor --L
Representative
COMMEROAL: V
PHONE:
stale Zip ,
4&721.
Slate Zip
CONTRACTOR
INFORMATION:
Diy
APPLICANT
INFORMATION: Property Owner
(or agent)
OR
TYPE of WORK:
RESIDENTIAL:
PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
JS,...
~<;,
Au.
.3J
Qly
STREET
30
STREff ADDRESS (INSPECTION LOCATION):
Qly
INSPECTION
INFORMATION:
TIME OF INSPECITON:
o UPGRADE SERVICE: From
to
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
~NO
DYES
TYPE OF IMPROVEMENT:
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
Number of NEW CIRCUITS:
Number of METERS: L
I CERTIFY THAT THE INFORMATION C NTAINED
ON THIS FORM IS COMPL AN AC URATE.
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECITON or RECONNECTlON TO A RELOCATED
STRUCTURE'.- PRINT
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Perrnlts/FormsJElectrlcal Application Apr 2006