HomeMy WebLinkAbout08010082 Applicationf??Y of cA M.
r` M tRFti1l 7pC
City of Carmell Clay Township two APPLICATION FOR ELECTRICAL INSPECTION
NAME PHONE FAX
CONTRACTOR .?CCr?Cj 3/7 v1- l l = v
INFORMATION: Street Address city state Zip
NAME CONTACT PHONE;
APPLICANT S
INFORMATION: Property Owner- Contractor
`
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY X7r
OWNER
INFORMATION : STREET
ADDRESS:
CIN
state Zip
/.? 7 7 L f f r C f 7, z l-.5 ?
STREET ADDRESS (INSPECTION LOCAT]0N): Cfty Zip
State
INSPECTION - V
3J ? y i f
/+
INFORMATION:
D OF INSPECTI TIME OF INSPECTION:
TYPE OF IMPRO T:
? UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
? ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
0 NEW METER SERVICE (Le, 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
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
? YES ? NO
Number of NEW CIRCUITS:
Number of METERS:. I J
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
Signature
PRINT DATE
COMMENTS ¢r)FURTHER LOCATION CLARIFICATION: (Please attach man of inspection location)
FEESN-,$ 104.00 for Comm*cial Inspections; $ 57.50 for Residential Inspections I