HomeMy WebLinkAbout06110132 Application
.pity of Carmell Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
FAX I
I
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Zip
CONTRACTOR "
INFORMATION: Street Address
~
State
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NAME
CONTACT PHONE:
APPLICANT . ,t.j",f {';: /71
INFORMATION: Property Owner
( or agent) S I;"; c:..
OR
Contractor i- ~~ ,;4;'6/t.-
Representative
TYPE of WORK:
.. RESIDENTIAL:"
'" COMMERCIAl:::
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PROPERTY OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:
S/3
STREET ADDRESS:
City
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state
state
I
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t/cs
STREET ADDRESS (INSPECTION LOCATION):
Oty
INSPECTION
INFORMATION:
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C 1:'1.-- ~"';U;L.
TIME OF INSPECTlON:
w .c,
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DATE OF INSPECTION:
/'1'
TYPE OF IMPROVEMENT:
/'
o UPGRADE SERVICE; From
to
:
DYES
~ NO"
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of NEW CIRCUITS:
Number of METERS:
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE:
..AC//..A"" e,.~~ I
Signature
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
.Ar CONNECTION or RECONNECTION TO A RELOCATED
. STRUCTURE . .
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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PRINT
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DAn
~ _ FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
~):permlts/FormS/EIectr1cal Application Apr 2006