HomeMy WebLinkAbout07110126 ApplicationT F City of Carmell Clay Township D I
1 G . 1 APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR In1c. I? - a - 58 30.9 NS
INFORMATION: sveetm&E? city Smre hp
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NAME CONTACT PHONE:
APPLICANT A rvt ov(pL-n ttf SfS Z ~ !v
INFORMATION: property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL;
PROPERTf OWNER NAMEIS): PHONE:
PROPERTY $ { -T se nfIF -&00 3i 4- 3a - 0-7
OWNER
INFORMATION: I ADDRESS: c1ty State Tip
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STREET AODRESS(1NSPECTION LOCATION): city State ZT
INSPECTION
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INFORMATION:
DATE OF INSPECTION ! I a 7 TIME OF INSPECTION:
TYPE &IMPROVEMENT-
O UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN E)GSTING ELECTRICAL DISTRIBUION SYSTEM
X 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?
? YES 'mil NO
Number of NEW CIRCUITS:
Number of METERS: a-
I CERTIFY THAT THE INFORMATION ONTAINEDi
ON THIS FORM IS C MPLETE D A URATE.
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PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach man of inspection location)
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FEES: $ 204.00 for Commercial Inspections; $ S7.50 for Residential Inspections