HomeMy WebLinkAbout07110133 Application4`+ OF c rAej„ Pcv7// ai 33
ate. City of Cannel/ lay Township
a - ! APPLICATION FOR ELECTRICAL INSPECTION
.. NAME PHONE FAX
CONTRACTOR c T l?/C. fit} -Z -$59 3t?-`} (s?IS
INFORMATION: steel Address City SWW ZIP
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NAME CONTACT PHONE:
APPLICANT" AD wl wlycEmcif -3(7 -75 Z- lv
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL: -A -
PROPERTY OWNER NAME(S): PHONE:
PROPERTY ?? T SE t - 3t- C?3 2- o
OWNER -
INFORMATION:
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$030 ,Qoe?SEVEt?T ?E ?i?1AtMtA G1 /I? ?(G?8
STREET ADDRESS M4SPEMON LOCATION: CRy. State -- ZIP
INSPECTION Zc; f
INFORMATION:
DATE OF INSPECTIwill
/" / TIME OF INSPECTION:
TYPE-OF IMPROVEMENT: "VING SERVICE FROM OVERHEAD
I O UNDERGROUND?
O UPGRADE SERVICE: From to O YES NO
O' UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
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 R€CONNECRON TO A RELOCATED
STRUCTURE
Number of METERS: --I-
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPUTE AWD ACCURATE.
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COMMENTS or FURTHER LOCATION CLARIFICATION:
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FEES: $104.00 for Commercial Inspections; $ SMO for Residential Inspections