HomeMy WebLinkAbout07100102 ApplicationCity of Cartnell Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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CONTRACTOR NAME J PHONE
CAM A -C Ccj vA ` FAX
INFORMATION: Street Address city state ZIP
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APPLICANT NAME A CONTACT PHONE:
A
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY PROPERTY OWNER NAME(S): PHONE: q y D
OWNER
INFORMATION:
stR ADDRESS:
city
state
zip
STREET ADDRESS (INSPECTION LOCATION): city State ZIP
INSPECTION
INFORMATION:
DATE OF INSPECTION:
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
? UPGRADE SERVICE: From to
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES 0 NO
O UPGRADE PANEL BOARD(S)
? ADDITION, ALTERATION, REMODEL, or REPAIR TO
"N AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
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 CLARIFICATION:
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THI FORM IS C AND ACCURATE.
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PRINT DATE
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FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspection
S:Perrnits(Forrns(Electiczl Application Apr 2007