HomeMy WebLinkAbout07120037 Application?ti'1 aF'?ag\
City of Camel/Clay Township
APPLICATION FOR ELECTRICAL. INSPECTION
?NaEANP-' * 0"7 f -7
NAME /
CdOI 4 ;h eer, n?
r PHOiJE FAX
3/7.Z5 0 - y/62 2
CONTRACTOR
INFORMATION: Street Address aty state zip
Box b'(S Ca m e / z U y6
NAME F?•!,
??flvQ SOS CONTACT PHONE: i
3/7-252--6//SZ
APPLICANT
INFORMATION: Property Owner Contiracwr
(or agent) OR Representative
TYPE of WORK: RESIDENTLAL: COMMERCIAL: X
PROPERTY OWNER NAM E(5): PHONE: /
!! 70
PROPE
R ou J? /' O o, fi eS A/F
OWNE
INFORMATION: s Rff ADOrtEss city state Z(a
ban ?F, 40,,i .e%;;e Al Carry!c I 1.d Y6a32
SKEET AcDRESS (INSPECTION LOCAUON): city State Zip
INSPECTION ZZ Cacme? YSOj2
,INFORMATION:
DATE OF INSPECTION: '
In / /6
TIME OF INSPECTION j'
7
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
I) ADDITION,,ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
jX NEW'METEP SERVICE (i.e. Fountain in pond;
Subdivision'street or signage_lighting,.Installation of
new utility services for an area) ecortecf?vt G?/rkj
O ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
O CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
Pd
MOVING SERVICE FR6*F RHEAD
TO UNDERGROUND?
? YES D NO
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM 15 COMPLETE AND ACCURATE.
Sicrature
PRINT
DATE
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
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5`. Fermi /FOrrralElettriaf Apitkatlor.Apr 21007