HomeMy WebLinkAbout07080242 Application/SV OF Cqq? OB /q/ ^/
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City of Cannell Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
? YHOIAN?
NAME PHONE FAX
CONTRACTOR `l9 / 333! 62- 3 6969
INFORMATION: street Address cry state Zip
PO /Sort 36a j-6 -;w0t O .Z/v Z16 z 3 L
NAME CONTACT PHONE:
APPLICANT 1?°/'K lv?? amt?` 41S / 3 3.5 /
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: /
RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE: S 7 _ 97/6
PROPERTY J l/ 1 ! (fo /L/L C R2?? C -T^t X16 e 3 3
OWNER
INFORMATION: ??ADD'ss' °v Sate LP
3YO a'/ ?r E c go?Ec
STREET ADDRESS (INSPEMON L
N): j - '78 °ty state ZJP
INSPECTION
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INFORMATION:
DATE OF INSPECTION: TIME OF INSPECTION:
TYPE OF.IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O UPGRADE SERVICE: From /00 to Za 0
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 orsignage 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
E YES O NO
Number of NEW CIRCUITS: U
Number of METERS: /
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
A?? Gvt
Signature
MA/L< V-) 'q T130 16 7
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
FEES: $ 104.00 for Commercial Inspections;?$ 57.5O f r Residential Inspections
5:Perrnits/Forru/Electrical Applkadon Apr 2007