HomeMy WebLinkAbout06080041 Updated Application
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City of Cd1'mell Clay Township ~ ( , "I 0-
APPLICATION FOR ELECTRICAL INSPECTION
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PHONE FAX
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Oty State Zip
0325
CONTACf PHONE:
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Contractor A
Representative
,- <.,-.' COMMERCIAl:
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Wil~il">\.,'.5 r
City State Zip
AMEL IJ
City State Zip
NAME
CONTRACTOR k"
INFORMATION: Street Address
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NAME
APPLICANT
INFORMATION:
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Property Owner
(or agent)
OR
TYPE of WORK:
,- RESIDENTIAL: .'
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PROPERTY
OWNER I
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INFORMATION: '
STREET ADDRESS:
\ .110) ( FOX C-L-(}ue c
STREET ADDRESS (INSPECTION LOCATION):
INSPECTION
INFORMATION:
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L(6(] )
j' / ~ TIME OF INSPECTION: I
,
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? I
o YES ~, NO
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TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From L{ 00 to fo ()(J '-"'M jJ
o UPGRADE PANEL BOARD(S) i JA
M, ADDmON, ALTERATION, REMODEL, or REPAIR TO ~
"'" AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of NEW CIRCUITS:
I
Number of METERS:
I
o NEW METER SERVICE (Le, Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
I CERTIFY THAT THE INFORMATION CONTAINED
ONUXM:QX;JCCURATE,
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Signature ,3Y';z..-OJ>Of'
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PRINT DATE
o ROW SIGNAL, SENSOR, MONITOR (i,e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
FEES: $ 100.00 for Commercial Inspections; $
\
6r Residential Inspections
S:PermltsjForms/Electrical Application Apr 2006
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