HomeMy WebLinkAbout07100058 ApplicationCity of Cannel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR Ae -;17- ?iLYrC??/Cr ?/7- 7 y 31'7 X-UUrS"
INFORMATION: Street Add: ess City Stad Zip
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NAME OONTACT PHONE:
APPLICANT X,rT i -7 7S?
INFORMATION: Property Owner Contractor
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(or agent) OR Representative
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TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY X
OWNER
INFORMATION:
ary
STREET ADDRESS.
state
Zp
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STREET ADDRESS (INSPECTION LOCATION): City state Zip
INSPECTION /373 O p
INFORMATION:
I DATE OF INSPECTION:
TIME OF INSPECTION:
/O o m K-
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O UPGRADE SERVICE: From to
? UPGRADE PANEL BOARD(S)
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
O NEW METER SERVICE (i.e..Fountain in pond;
Subdivision street or signage lighting; installation of
new utility services for an area)
? ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
? CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
O YES ? NO
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
signature
?L/iirT P?.iT !O?
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
SCANNED
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:Perrnlts/Farms/EIectHcal Appiicadon Apr 2007