HomeMy WebLinkAbout07090128 ApplicationCity of Carmell Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
119 1?209 0 /.z IF
NAME PHONE FAX
CONTRACTOR L0 2 - iso - l -19`+3
INFORMATION: Street Address Crty state Zip
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NAME
CONTACTPHONE: _
APPLICANT
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY {` 20 3 v c a _ -F- t 2
OWNER
INFORMATION:
SEE'" RESS:
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sacs
vv
1020 37'V arms SLJ L t? 1-1loo3Z
STREET ADDRESS (INSPECTION LOCATION): - City State LP
INSPECTION 16/ q-oo a-
INFORMATION:
DATE OF INSPECTION: TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
MOVING'SERVICE FROM OVERHEAD
TO UNDERGROUND?
CX' UPGRADE SERVICE: From to (1m A
O UPGRADE PANEL BOARD(S)
E?( 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
COMMENTS or FURTHER LOCATION CLARIFICK
O YES ?g- NO
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
Signature
Ps:c tP,F [p l.wq-yErL -) / 2l-, )-zoc'
PRINT DATE
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:PenMs/Fonn;?Electrical Application Apr 2007