HomeMy WebLinkAbout08010084 Applicationz f'? City of Carmell Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR t
INFORMATION: street Address City state zip
2--.
NAME CONTACT PHONE:
APPLICANT IA- 3 3 °`A5
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORD: RESIDENTIAL: _ COMMERCIAL:
PROPERTY OWNER NAM€{S): PHC1NE:
PROPERTY
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OWNER
INFORMATION' srREETAOORESS: city state zp
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STREET ADDRESS (INSPECTION LOCATION): City State Zlp
INSPECTION = - `-
INFORMATION: ?
DATE OF INSPECTI09V:;' r I ?? ja-- ti TIME OE INSPECTION: ') }lr
TYPE OF IMPROVEMENT: / MOVING SERVICE FROM O
_ TO UNDERGROUND?
W UPGRADE PANEL
to
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
O NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
C ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
? CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
C7 YES ?d NO
Number of NEW CIRCUITS: 2-40
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach ma of inspection location)
FEES: $ 104.00 for Commercial Inspectionsk S7.SO for Residential Inspections
5:Pernit5lF rmslElectrlcal Application Apr 2007
Number of METERS: 4