HomeMy WebLinkAbout06080096 Application
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\" J APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
FAX
CONTRACTOR
INFORMATION:
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aty
State
Zip
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APPLICANT
INFORMATION:
NAME
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Property Owner
(or agent)
CONTACT PHONE:
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OR
Contractor V
Representative -4-
COMMERCIAL: X'..
TYPE of WORK:
... RESIDENTIAL:;.
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
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PHONE:
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STREET ADDRESS:
City
State
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STREET ADDRESS (INSPECTION LOCATION):
IS 1-'-1 hEl-D S
DATE OF INSPECTION:
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City State
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TIME OF INSPECTION:
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INSPECTION
INFORMATION:
MOVING SERVICE FROM OVERHEAD .
TO UNDERGROUND?
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
DYES
o NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
Number of METERS: \
I CERTIFY THAT THE INFORMATION CONT ED
ON THIS FORM IS COMPLETE D ACC RA
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
X 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 (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
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PRINT
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DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
New 'Pov.)-cJ(.. S\At1PL-Y CA"8ltJE7 F2>~ i3~lG~TJ-foV\St cA'B~
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/FOnTls/ElectrlcaJ Application Apr 2006