HomeMy WebLinkAbout07070192 Application
City of Carmelfi@lay Township
APPLICATION FOR ELECTRICAL INSPECTION
O'lO'lD PL
NAME PHONE FAX
INTRACTOR ~ I liVe.. ~l=l-- S-~ . ~I=I- Ti-"'I t.l/5'
FORMATION: Oly State ZJp
IS .rJ
NAME CQNTACf PHONE:
'PUCANT A cJf ~(T -'?-52--1t.>
FORMATION: Contractor L
OR Representative
PE of WORK:
RESIDENTIAL:
COMMERaAL: )(
PROPERTY OWNER NAME(S):
PHONE:
~OPERTY
VNER
FORMATION:
B
3(
STREET ADDRESS:
Oly
State
ZJp
30 irO 2eosE:.vcI.--, tiE.
SfREET ADDRESS (INSPECTION lOCATION):
SPECTION I/(po
FORMATION: I, (.J
!,J/;)'/ttU
Oty
,tJ
~(,Z1~
State
ZJp
r2w\EL rJ
TIME OF INSPECTION:
rPE OF~IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
:J UPGRADE SERVICE: From
to
DYES
()( NO
:J UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
Number of METERS: .1-
:J ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
lit' NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area) .
:J ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
I CERTIFY THAT THE INFORMATION C
ON THIS FORM IS COMPLETE D AC
:J CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
IMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
~/lJttL. 5tA-f>P'-1 CrA(~flUt:7 Foe -&2(6(f-r/-{cYt.t'OE ~LG LOU'l:,tD OrJ
~lk\"tf -we", C.DP-I\.j€R- or IILP5'/ v-J*'~Pe-(L aA:f c:r:.
FEES: $104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
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