HomeMy WebLinkAbout07080193 Application_`ty oc Gqg?
?' y"ATriFRSy??!
City of Cannell Clay Township
w p APPLICATION FOR ELECTRICAL INSPECTION
/p
NAME FAX
PHONE
E?
C
?
`l l t
??1-1? ?3?-'L4t 1-1 l 7??
l
`
1 (
CONTRACTOR c
-
-
- e
t
o
5
INFORMATION: Street Address state zip
city
\?Q J? T
?1ArA 'T_- ?Ibol3Ci
NAME CONTACTPHONE:
APPLICANT 3\_j -7_c`,--?71 i
INFORMATION: Property Owner Contractor
(or agent) OR Representative
/
TYPE of WORK: RESIDENTIAL: ? COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY C QC ??l ?- S 17 - ?L
OWNER
INFORMATION:
STREnETAD?DRESS: ?? ?,ec5c
e
+ L?O?r aty State Zip
`
.
LC> r cv fi a
??t qL0 03
STREET ADDRESS (INSPECTION LOCATION): city State zip
INSPECTION ? W p c? ?iat? Cke?? ?Clrn u?E?y6d3\{
INFORMATION:
DATE OF INSPECTION: TIME OF INSPECTION:
TYPE'OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
? UPGRADE SERVICE: From to
? UPGRADE PANEL BOARD(S)
? ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
[Vj NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
? ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
D CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
D YES LK' IVO
Number of NEW CIRCUITS:' 3
Number of METERS: i
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS ORM IS COMPLETE AND ACCURATE.
SIggnatvee 1
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach man of inspection location)
t
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:Penn1ts/Forms/E1ectnu1 Application Apr 2007