HomeMy WebLinkAbout07060008 Application
CifyojCanneffir5lay Township 7~ o/~
APPLICATION FOR ELECTRICAL INSPECTION
670/'; Cf)
NAME
PHONE
FAX
CONTRACTOR
INFORMATION:
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NAME
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CONTACT PHONE:
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APPUCANT
INFORMATION:
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TYPE of WORK:
RESIDENTIAL:
Contractor L
OR Representative
COMMERCIAL: X
PHONE:
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Property Owner
( or agent)
PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
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STREET ADDRESS:
3<>"iO 2.oeSEVtE:t..:I o/€
STREET ADDRESS (INSPECTION LOCATION):
INSPECTION
INFORMATION:
TIME OF INSPECDON:
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
~ NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
Number of METERS: .1..
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~
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 CONNECDON or RI<CONNECDON TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDectfon location)
;JclAJ c:A-iS( G 'POWtP-... S"uPPL-'( ~(N~T oN SIDE' of -p(Lo'PeJ2."(
FEES: $104.00 for Commercial Inspections; $ 57.50 for Residential Inspections