HomeMy WebLinkAbout07100141 Application`N Ca` Aq??
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APPLICATION FOR ELECTRICAL INSPECTION
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NAME ( PHONE FAX
.
CONTRACTOR ?) 3
3 ? l
INFORMATION: Stree:Adcress atp State zip
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NAME CONTACTPHONE:
APPLICANT I
rt
INFORMATION: Property Owner Contractor /
(or agent) OR Representative V
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY
0
OWNER
INFORMATION: STREET ADDRESS: ary State zip
OU 6
STREET OADDR SS NSPECTION LOCATION): City State Zip
INSPECTION
INFORMATION:
DATE OF INSPECTION: TIM OF INSPECTION:
TYPE OF IMPROVEMENT:
0 UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
{ 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
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES ?9 NO
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
PRINT DA
ENTS or FURTHER LOCATION CLARIFICATION:
FEES: $ 104.00 for Commercial Inspections $ 57.50 !'Pr Residential Inspections,
S:PerrityFerms/ElectricarAppliudon Apr 2007