HomeMy WebLinkAbout07100159 Applicationv\1y of Cgq?F??-/'/7 /I L?)
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( City of Carmell Clay Township OD
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e, u w= APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR 15"-,Ilqlj ? 3/ 7) `6 Ca-//33
INFORMATION: Street Address city State fzJp
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NAME CONTiACT PHONE:
APPLICANT 131ellil-J 5TF! 3/7) VAV- SOS
INFORMATION: Property Owner Contractor
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(or agent) epresen
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TYPE o
WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY ,, Cc ICAA [?2UK? t? T .3711- 3VO b
OWNER
INFORMATION:
srREETaoorEss:
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- New r??.L/SFr .9RznC- C, s? 3 2
STREET ADDRESS (INSPECTION LOCATION): City State Zip
INSPECTION O S cAA,#W & - -1-;'d
INFORMATION:
DATE OF INSPECTION: TIME OF INSPECTION:
TYPE OF IMPROVEMENT-------L------' MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
>S NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services or an area
O ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
O CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
O YES O NO
(/) ^O $
Number of NEW CIRCUITS/?2-?) / O
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
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Signature
,3g /d 1017s7-FC. / A 0 7
PRINT Z DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
c 11145'6S /3ANK ,co c gTF/? (p /.3/ s7--,--7-,6,N6 26
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:Permits/Forms(Electrkal Applkadon Apr 2007