HomeMy WebLinkAbout07080231 ApplicationCity of Carmd l Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
NAME PHONE FAX
/?' TSB It4J
? 538 B
CONTRACTOR ??? ?
INFORMATION: Sweet Address Zip
city State
NAME V
CONTACr PHONE:
APPLICANT dao,
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL:_ COMMERCIAL:
PROPERTY OWNERNAME(S): PHONE:
PROPERTY /oaS? pr-6\c'? -i Arv-- 50 DS- LF("?fv
OWNER
INFORMATION: STREET ADDRESS: city state ZIP
STREET ADDRESS (INSPECTION LOCATION): city state Zip
INSPECTION
INFORMATION:
DATE OF INSPECTION: TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
Y UPGRADE SERVICE: From to -20 Ar, p
O UPGRADE PANEL BOARD(S)
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
O 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 CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES X NO
Number of NEW CIRCUITS:
Number of METERS: I
I CERTIFY THAT THE INFORMATION CONTAINED
O IS FORM IS COMPLETE AND ACCURATE.
Signature
?.meter I-? Ce-r-r-e5 gI3'ilUl
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
I FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
:Permits/FOrmslElecvical Application Apr 2007
City of Cannel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
42 OR 0a 3el
NAME PHONE FAX
CONTRACTOR C
'S ?SG'YL4J 5 36 - q 418
INFORMATION: Street Address city State
Bp
NAME CONTACT PHONE: p
fjCr {??J c?0
APPLICANT
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY load ors ?i?'? 5()- Dr z2Lt„4
OWNER
INFORMATION:
STREET ADDRESS:
City
State Mp
STREET ADDRESS (INSPECTION LOCATION): Gty State Zip
INSPECTION
INFORMATION:
DATE OF INSPECTION:
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
Y. UPGRADE SERVICE: From f? to -2i?O A, , p
O UPGRADE PANEL BOARD(S)
O ADDITION, ALTERATION; REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
O 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 CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES > NO
Number of NEW CIRCUITS:
Number of METERS: I
I CERTIFY THAT THE INFORMATION CONTAINED
O IS FORM IS COMPLETE AND ACCURATE.
Signature ?-
??rtr?s
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:Permits/Forms(Electrical Application Apr 2007