HomeMy WebLinkAbout07110125 Applicationcr oP;Cgq?`
City of CarmeltClay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR c . INc. 314 - 5-8 - Yf - ?-9 A&415-
INFORMATION: Street Addr aty state Up
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NAME Ci7NTACr PHONE:
APPLICANT A Wk cFF
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL: .-
PROPERTY OWNER NAME(S): PHONE:
PROPERTY -r 5E E-
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OWNER
INFORMATION: STREET AD': CRY state zip
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STREET ADDRESS (INSPECTION LOCATION): City state Zip
INSPECTION ( 3 9 8" f(?}?? ,?, c1412nnc- r_ f?
INFORMATION:
DATE OF INSPECTIO
vZ 7
TIME OF INSPECTION:
OVING SERVICE FROM OVERHEAD
TYPE OF IMPROVEMENT:
TO UNDERGROUND?
O UPGRADE SERVICE: From to O YES u'l NO
O UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM Number of METERS: 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
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE ND CURATE.
Signature
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40(d'?
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
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-Fr2--O..s S $ Z e--
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections