HomeMy WebLinkAbout06100003 Application
City of Carmell Clay 'Township -=tf= () 6 / 60003
APPLICATION FOR ELECTRICAL INSPECTION
NAME
PHONE
FAX
CONTRACTOR
INFORMATION:
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City
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State
Zip
Street A.ddress
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"/6203
NAME
CONTACT PHONE:
APPLICANT
INFORMATION:
L. S-rr...h.er
Property Owner
(or agent)
OR
Contractor
Representative x..
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PROPERTY OWNER NAME(S):
PHONE:
Xc.,. .:
i
5?/-oJ"6J '
TYPE of WORK:
,.. RESIDENTIAL:,
COMMERGIAL:,
PROPERTY '
OWNER
INFORMATION:
S i-V\(; iLl?
R10C'C ItOiMi?' OW-I'\" e'i~ S lI.fS Of
STREET ADDRESS:
City
State Zip
,
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I'
Oty Slate
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TIME OF INSPECTION:
Zip
STREET ADDRESS (INSPEC110N LOCATION):
INSPECTION 52 H/!!::!...ttlOIZAJ OIL t-J,
INFORMATION: _~
DATE OF INSPECTION:
r;6cJ~J
TYPE OF IMPRO
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
o UPGRADE PANEL BOARD(S) , 51/ ..:- ;fJ-! tf Ii
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of NEW CIRCUITS: /
Number of METERS: /
DYES
o NO
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
I
/cJ/z/bD'
DATE I
I
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)'
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I V f
o CONNEcrION or RECONNEcrION TO A RELOCATED
STRUCTURE
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PRINT
$ 100.00 for Comm rcial Inspections; $ 55.50 for Residential Inspections
$. ennlts/Forms/ElecbicaJ Application Apr 2006