HomeMy WebLinkAbout06090144 Application
CityofCarmellClayTownship ~ (}~090/n
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APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
FAX
CONTRACTOR
INFORMATION:
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Street Address
State
I
Zip
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Property Owner
(or agent) 5 /3('
OR
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Contractor t .At J i do.l
Representative r'<.-
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,..COMMERCIAl: ~,/JiI':'<
CONTACT PHONE:
NAME
APPLICANT
INFORMATION:
TYPE of WORK:
,. RESIDENTIAL: "
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STREET ADDRESS (INSPECTION LOCATION):
PHONE:
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oty State
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City State
Zip
t
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Zip
PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
St3c
STREET ADDRESS:
INSPECTION
INFORMATION:
G-
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TIME OF INSPECTION.
'6
DATE OF INSPECTION:/fJ.
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TYPE OF IMPROVEMENT:
IO-;).-O(p
MOVING SERVICE FRO
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
gNO
o UPGRADE PANEL BOARD(S)
~
Number of NEW CIRCUITS: I
o ADDmON, ALTERATION, REMODEL, or REPAIR T~ I
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM ~ Number of METERS: 'I I
\,( NEW METER SERVICE (i.e. Fountain in pond; , I CERTIFY THAT THE INFORMATION CONTAIf'lED
^ Subdivision street or signage lighting; Installation of ON THIS FORM IS COMPLETE A ACCURATE.
new utility services for an area)' ,
ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
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ftr
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PRINT
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~6.46
DATI!'
CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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$ 100.00 for Commercial Insp ions; $ 55.50 for Residential Inspections