HomeMy WebLinkAbout07050160 Application
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CONTRACTOR
INFORMATION:
City of Cannell Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
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P~ONE
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S'tret!tAddress
';140 L
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APPUCANT
INFORMATION:
NAME
ibb Le..
CONTACf PIroOf: .
Property Owner
(or agent)
OR
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Contractor \,./
Representative ^
TYPE of WORK:
RESIDENTIAL:
COMMERCIAL: ')(.
PROPERTY
OWNER
INFORMATION:
PIUlPER'N OWNER NAMf(S): PHONE:
CY'OOkad. ~k ti~l{ C.L.v..6 '?\1- ~'-lcl.f-tj~~g
"\ei~~n~ I,(~ \,.",- u.x-~JJ IN Slate lfbD31.
INSPECTION
INFORMATION:
. iiJ~(I~A~d~~ L",. ~'MtJ.
Sta..
It-.)
lip
410 07;,2....
DATE OF INSPECTION:
TIME OF INSPECTlON;
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
o UPGRADE PANEL BOARD(S)
o ADDmON, AL TERAl10N, REMODEL, or REPAIR TO
AN EXI5l1NG ELECTRICAL DISTRIBUION SYSTEM
'Ii{ NEW METER SERVICE (i.e. fountain in pond;
Subdivision street or signage IIghttng; Installation of
new utility services for an area)
to
o YES
~NO
Number of NEW CIRCUITs:
o ROW SIGNAL, SENSOR, MONITOR (I.e. Traffic Ught)
o CONNECTlON or RECONNECTION TO A RELOCATED
STRUCTURE
Number of METERS:
I CERTIFYTHATTIiE INFORMATION CONTAINED;
ON THIS FOR~MPLETE AND ACCURATE. I
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FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Resid~ntial Inspections
S:P.....""'FonnSiEIedncaI Application A;Jf z007
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