HomeMy WebLinkAbout07110088 Application?.? or CAg? \
£Z City of Carmell Clay Township 0780099
ttu ' APPLICATION FOR ELECTRICAL INSPECTION
?!NDI??
NAME PHONE FAX
CONTRACTOR 12G 2,Ze
INFORMATION: Street Address city state Zip
1.4368 G Svuf'PO t„ le. e ?iva?ircA °Lig g.pioiaa? f/lzs?
NAME CONTACT PHONE:
APPLICANT . L6 ewr C. 1"77-
INFORMATION: Property Owner
J Contractor
OR
(or agent) Representative
v
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY r
OWNER
INFORMATION:
STREETADDREss:
city state
zip
STREET ADDRESS (INSPECTION LOCATION): - City state Zip
INSPECTION Y/v:s- al. /li(tZ 5ieev'
INFORMATION:
DATE OF INSPECTION:
TIME OF INSPECTION:
.cG e'A"-4 TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
D UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
D ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
D NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
`D' ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
CONNECTION or RECONNECTION TO A RELOCATED
/ STRUCTURE
O YES O NO
Number of NEW CIRCUITS:
Number of METERS: I
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE CCURATE.
Signaltum
PRINT ATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:Pennlts/Forrns/Electrical Applicatlon Apr 21307