HomeMy WebLinkAbout07050137 Application
City of Carmelli@lay Township
APPLICATION FOR ELECTRICAL INSPECTION
70~61 /37
NAME
PHONE
FAX
CONTRACTOR
INFORMATION:
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aty
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State Zip
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4feC
NAME
CONTACT PHONE:
~
APPUCANT
INFORMATION: Property Owner
(or agent)
OR
'3(~ -7-52--/0
Contractor
Representative L
TYPE of WORK:
RESIDENTIAL:
COMMEROAL: )(
PHONE:
3(
aty State Zip
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aty State Zip
PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
STREET ADDRESS:
30 irC> 2-00s,E:I/Cl--, ,,€
SfREET ADDRESS (INSPEcnON LOCATION):
INSPECTION
INFORMATION:
s7
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
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: j...
)4
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 INFORM ;nON CONTAINED
ON THIS FORM IS COMPLETE ND AC URA <
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDectfon location)
tlc.v.J cAlSL~ T..!. t'bvJe.e '5U-PP'--Y cA i?rAJET B.: H-IIV7:::> I 2- 9 z-? SA(tV~&t.'-'~Y ST C8~f>~)
a.:r -"D'-I.I<-E: PoLE:tf 8~J>' ~ (;Z4L(
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections