HomeMy WebLinkAbout06070157 Application
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( ,. ~ ";" \ City of Cannell Clay Township
\"'.0". ) APPLICATION FOR ELECTRICAL INSPECTION.
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NAME
PHONE FAX
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Oty Stille z;p
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.3/7 - 8
Contractor ~
OR Representative
COMMEROAL: V
PHONE:
.31
Oty Stille ZIp
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oty Stale ZIp
CONTRACTOR e ec._
INFORMATION: StreaAddress
APPUCANT
INFORMATION: Property Owner
(or agent)
TYPE of WORK: RESIDENTIAL:
PROPERTY OWNER NAME(S):
PROPERTY J:S,....
OWNER
INFORMATION: SlllEET RESS:
30 ~";. A",
SlllEET ADDRESS (INSPECTION LOCATION):
INSPECTION I'll- s-r IIIIAI\1OL
INFORMATION:
DATE OF INSPECTION:
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 ADDfTlON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
. · i ~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 (Le. Traffic Light)
o CONNECTION or RtcONNECTION TO A RELOCATED
STRUCTURE '
I CERTIFYTI-fATTI-fE INFORMA
ON TI-fIS FORM IS COMPL A
d
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I
752 -lo9Lj
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
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