HomeMy WebLinkAbout05050137-ApplicationAPPLICATION FOR ELECTRICAL INSPECTION
NAME
PHONE FAX
APPLICANT
INFORMATION:
TYPE of WORK:
pROPERTY
INFORMATION:
Owner
(or agent) OR
Contractor
Representative
COMMERCIAL:
RESIDENTIAL:
INSPECTION
INFORMATION:
PROPERTY OWNER NAME(S):
STREET ADDRESS (INSPECTION LOCATION):
ETREET ADDRESS (INSPECT[ON LOCATION):
TYPE OF IMPROVEMENT:
C~ UPGRADE SERVICE: From ~'0/~
DATE OF INSPECTION:
UPGRADE PANEL BOARD(S) [AFCI BREAKERS R£QUIRED]
ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
PHONE:
OiLy ~ State Zip
City State Zip
TiME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
0 YES ~NO
Number of NEW CIRCUITS:
Number of METERS:
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)
[] CONNECTION or RECONNECTiON TO A RELOCATED
STRUCTURE
I CERTIFY THAT THE
ON THIS FORM
ACCURATE,
DATE
~:OMMENTS or FURTHER LOCA'r~ON CLARIFICATION: (Pleasea ch ma: of ins ection Iocai n)
Inspections; $ 52.00 for Residential Inspections