HomeMy WebLinkAbout07100068 Application`AOF Cq
City of Cannel /Clay Township
?- _ APPLICATION FOR ELECTRICAL INSPECTION
?Crou`aen. % 0%/ 1)006Y
NAME PHONE f`f p ) PAX
F
t, Gou?n r `tee f?t'gC I e'( -? -7271
CONTRACTOR .
INFORMATION: Street Andress oty state 21p
NAME CONTACT PHONE:
APPLICANT <?Z4-t°f- (0 -`3-7c-0
INFORMATION: Property Owner Contractor
X
R
t
ti
(or agent) OR ve
epresen
a
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY g Cp?DI (
-15? I Lte ? e Cq4 ? q1 3
r
OWNER
INFORMATION:
sFREErAnDRESS:
I E, CA-2K6L J2
?N state
C'asU-,eG
zip
INSPECTION STREET ADDRESS (INSPECTION LOCATION):
( F2- C hri -tel -1W, aty state
(a?'"'VL I /I/ 7Ip
W90 3z--
INFORMATION: _
DATE OF INSPECTION: l0 /,a 0-7
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
UPGRADE SERVICE: From 4100 to boo
O UPGRADE PANEL BOARD(S)
? 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)
? ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
? CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES jk"NO
Number of NEW CIRCUITS: A/11,
Number of METERS: Z
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
Signature
e !-e lr ?oLl- ht C2 [ ?, l l
PRINT ATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
FEES: ..104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
emlts!FomUEfectrkal ApplicaUQn Apr 2007
S:I