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HomeMy WebLinkAbout06100003 Application City of Carmell Clay 'Township -=tf= () 6 / 60003 APPLICATION FOR ELECTRICAL INSPECTION NAME PHONE FAX CONTRACTOR INFORMATION: ELU;[J? /ui-c-- E.tU(J;j2fl? i k Jpt c, ?.f'l-Z z. 2-,/ ~ r.; fC( 2.2- 97 57/0$ C}l-UI\UffrlJ4/v ;f'{/~ City :CIJ oil J State Zip Street A.ddress .r Iv' "/6203 NAME CONTACT PHONE: APPLICANT INFORMATION: L. S-rr...h.er Property Owner (or agent) OR Contractor Representative x.. 7.fi( -7- z- '- Y 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 , /36fi J41ctc:&-r2t'f}{J.E ft..rlc.{; G#/lIl:![ ...Ltv </6 0 3 j I' Oty Slate e Jli-fl-11A i ( ;:: )J 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)' S~J(//q Lcc.c./eJ So...+1" r-/c/t> (.I,hi 5,'o4.-fh i-Jc'/( C)+-r/ve. Il/c,ltfh ~v. -1-1" <<Vv<..E'.. 0 ( '5 "'u)k~7 {2. 'I,,,,(J () "'- r!cd e 1,1 /Zc/' (;ie. <'J 1~ ()<'1."- I);t.) I V f o CONNEcrION or RECONNEcrION TO A RELOCATED STRUCTURE 'DII-&tp {.. ';/~#{Jdlf-. PRINT $ 100.00 for Comm rcial Inspections; $ 55.50 for Residential Inspections $. ennlts/Forms/ElecbicaJ Application Apr 2006