HomeMy WebLinkAbout08010063 ApplicationCity of Cannel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR r. T =1G-c rf C51 7-) " - 5773 i 6 Dov
INFORMATION: Street Address city state zip
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NAME CONTACT PHONE:
APPLICANT 17 r6."- y?7
INFORMATION: Propert?wner Contractor
(or agent) - OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE'.
PROPERTY ?t-
OWNER
INFORMATION: STREET ADDRESS: City state Zip
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SIREETADDRESS (tNSPEMONLOCATION): City State Zip
INSPECTION
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NFORMATION:
DATE OF INSPECTION: TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O UPGRADE SERVICE: From to
0 UPGRADE PANEL BOARD(S)
D ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
D 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 Llght)
D CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
? YES L-71 NO
Number of NEW CIRCUITS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
Sig na ture
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:PermiM0F0rMSVEIeC.r1ca1 App lcation Apr 2007 2rL
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