HomeMy WebLinkAbout07100086 Application€ ~` City of Carmell Clay Township 7 /C 0 0
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR 6urr?w 3i7 gyrY i i ?6aoo
INFORMATION: Street Address city State 2IP
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APPLICANT
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INFORMATION: Property Owner Contractor
(or agent) OR Representative G o%?
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TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY
OWNER
INFORMATION: sTREErADDRESS: ar state np
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STREET ADDRESS (INSPECTION LOCATION): - city State ZIP
INSPECTION d'?rz -
INFORMATION:
DATE OF INSPECTION: TIME OF INSPECTION:
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TYPE OF IMPROVEMENT:
? UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
(M//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?
O YES O NO
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE A D ACCURATE.
Signature
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PRINT ATE
COMMENTS or FURTHER LOCATIOrj CLARIFICATION: (Please attach map of inspection location)
SCANNED
S:F
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
_rmits/Fon sjElectrtCal Appllcatlcn Apr 2007