HomeMy WebLinkAbout06120016 Application
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City of Carmell Clay Township
APPLICATION FOR EL~CTRICAL INSPECTIO~
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CONTRACTOR
INFORMATION:
NAME ,,7/ 6"L.I!~/~
,db"r C. a,~r
PHONE
FAX
Street Address
City
State
Zip
APPLICANT ,~
INFORMATION: Property Owner
(or agent)
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CONTACT PHONE:
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OR
Contractor
Representative
PROPERTY
OWNER
INFORMATION:
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'COMMEREIA~: . ';A ".,.4,;IN,~r;;,J~
PHONE: Lee "".6"~ I
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l'YPE',of WORK:,"
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PROPERTY OWNER NAME(S):
STREET ADDRESS:
City
State Zip
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STREET ADDRESS (INSPECTION LOCATION):
City
State
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INSPECTION
INFORMATION:
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DATE OF INSPECTION:
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TIME OF,INSPECTION: ...d
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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:
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of METERS:
,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.I
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Signature
o 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)
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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)
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$ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
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FEES:
S:Permlts/Forms/Electrlcal Application Apr 2006