HomeMy WebLinkAbout06090099 Application
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\.: . / APPLICATION FOR ELECTRICAL INSPECTION
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FAX
PHONE
NAME
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CONTRACTOR
INFORMATION:. StreelAddress
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Zip I
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State
Oty
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CONTACT PHONE:
NAME
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Property Owner V
(or agent) <\.
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APPLICANT
INFORMATION:
Contractor
Representative
OR
COMMERGIAl::~
TYPE of WORK:
.." RESIDENTIAL:"
PROPERTY OWNER NAME(S):
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PHONE:
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PROPERTY
OWNER
INFORMATION:
Zip !
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Zip I
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City
State
STREET AODRESS:
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CIty State
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TIME OF INSPECTION:
STREET ADORESS (INSPECTION LOCATION):
505Lj bC'<I,)~'^ <<",(f L;CJe
DATE OF INSPECTION:
INSPECTION
INFORMATION:
TYPE OF IMPROVEMENT: call 57/- {J-lflli
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
~"NO
DYES
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~/ NEW METER SERVICE (Le. FountairrTi'lpond;
//
Subdivision street or signag nghting; stailation of
new utility services for an rea)
Number of NEW CIRCUITS:
I
Number of METERS:
,
I CERTIFY TlrlATTHE INFORMATION CONTAINED
ON TH 0 M IS COMPLETE AND ACCURATE. I
. ,
o ROW SIGNAL, SENSOR, MONITOR (Le. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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DATE
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FEES: . 100.00 for Commercial I pections; $ 55.50 for Residential Inspections
al Application Apr 2006