HomeMy WebLinkAbout08010023 ApplicationrF,t.of CA `-, t
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r' City of Carmell Clay Township
' APPLICATION FOR ELECTRICAL INSPECTION
It??i3_?att? NAME PHONE FAX
3/7-
CONTRACTOR
INFORMATION: Street Address CttY State 21P
NAME CONTACT PHONE:
APPLICANT . G "ff r - rr 4-?17_)
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAMECS): PHONE:
PROPERTY T i
OWNER
INFORMATION: STREET ADDRESS: oty state Zip
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STREET ADDRESS (INSPECTION LOCATION); City State ZIp
INSPECTION
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r 1/11+/c?t
INFORMATION:
DATE OF INSPECTION- .T TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
Q UPGRADE SERVICE: From
O UPGRADE PANEL BOARD(S)
? ADDITION, ALTERATION, REMODEL,
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
I? YES ? NO
Number of NEW CIRCUITS:
Number of METERS: f
AN E)aSTINC ELECTRICAL DISTRIBUION SYSTEM
i 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)
C CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or
I CERTIFY THATTHE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND AC URATE.
Signature
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PRINT DATE
LOCATION CLARIFICATION: (Please attach map of inspection location)
gala 1 0 zoa$
By
FEES: ?$ 104.00 for +Ci6mmercial Inspections; $ 57.50 for Residential Inspections