HomeMy WebLinkAbout06070116 Application
City of Carmell Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
FAX
CONTRACTOR
INFORMATION:
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IN
CONTACT PHONE:
APPLICANT
INFORMATION: Property Owner
(or agent)
.317- 5Z-
OR
Contractor
Representative
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TYPE of WORK: RESIDENTIAL:
COMMERGAL:
PROPERTY OWNER NAME(S):
PHONE:
STREET
Slate
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PROPERTY
OWNER
INFORMATION:
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INSPECTION
INFORMATION:
30 ~.."
STREET ADDRESS (INSPECTION LOCATION):
13 4Ve.e.
DATE OF INSPECT10N:
.31
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Slate
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TIME OF INSPECT10N:
o UPGRADE SERVICE: From
to
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
~NO
DYES
TYPE OF IMPROVEMENT:
Number of NEW CIRCUITS:
Number of METERS: L
I CERTIFY THAT THE INFORM nON C
ON THIS FORM IS COMPLETE ND AC
o ROW SIGNAL, SENSOR, MONITOR (Le. Traffic Light)
Signawre
fJi
- 20-00
o CONNECT10N or RECONNECT10N TO A RELOCATED
STRUCTURE '.
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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PRINT
DATE
FEES: $ 100.00 for Commerciallnspectionsi $ 55.50 for Residential Inspections
S:Permlts/Forms/Electrlcal Application Apr 2006