HomeMy WebLinkAbout07030107 Application
City of Carmell Clay Township ~I~ '1,(
APPLICA TION FOR ELECTRICAL INSPECTION
2130/07
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NAME
CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
TYPE of WORK:
RESIDENTIAL: v---
PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
STREET AODRESS:
PHONE
FAX
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City
State
Zip
CONTACT PHONE:
OR
Contractor
Representative
v
COMMERCIAL:
PHONE:
City
State
Zip
STREET ADDRESS (INSPECTION LOCATION):
City
State
Zip
INSPECTION
INFORMATION:
DATE OF INSPECTION:
3./
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
arADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
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)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
/c",,$ ,,?n,X C?/7 Go.;?/" /2:'H/
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TIME OF INSPECTION: 7
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
~NO
Number of NEW CIRCUITS:
Number of METERS: /
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
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PRINT
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(Please attach map of inspection location)
- 09/1
FEES: $ 100.00 for Commercial Inspections; $'55:50 for Residential Inspections
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S:PermltslFormsjElectrlcal Application Apr 2006
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