HomeMy WebLinkAbout07080019 Application
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CONTRACTOR
INFORMATION:
City of Cannell Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
Olo?; WI
NAME
\
State
ZIp
Lee
Co
il
1,aLY -35301
street Add"i!liS
ItJ
LfCJOl N. ben 1
. N/.ME
APPUCANT
INFORMATION:
.3ll-
Property Owner
(or agent)
OR
Contractor
Representative
. TYPE of WORK:
RESIDENTIAL:
COMMERCIAL:
PROPERTY
OWNER
INFORMATIOt4:
I'ROP8<IY OWNER NAME(S):
HT -IT
PtION~:
ST'REET ADDRESS (INSPECTION lOCATION):
Clty
Ind Is
Slatl!
Zip
'/iPJ[J<j
INSPECTIOt4
INFORMATION:
adO N Mericlf
~ ADDRESS (INSPECTION lOCATION):
J'/laN~
N
Clty
Stol2
Zip
TYPE OF IMPROVEMENT:
o uPGRADE SERVICE: From
to
o YES
)(1'40
o UPGRADE PANEL BOARD(S) {AFCl BREAKERS REQUIRED]
o AOOmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECfRlCAL DI5TRIBUION SYSTEM
Number of NEW CIRCUITS:
o NEW METER SERVICE (I.e. fountain in pond;
Subdivision street or slgnage lighting; Installation of
new utility services for an area)
;zf'ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (please attach mal) of inslleCtion location)
Prone: r(~hine}
FEES: $o.~or Commercial Inspections; $ 52.00 for Residential Inspections
S:Pennlt!ilForms/EIectrIc:a1 ApplIcation oct 2003
(Dlf..6b
Map of 11112 N Gray Rd Cannel, IN by Map Quest
Page 1 of2
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* 11112 N Gray Rd
Carmel, IN 46033-9703, US
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entire map, try clicking the "Printer-Friendly" link at the top of your results page.
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