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HomeMy WebLinkAbout05090114-ApplicationSEF i9 ~11 ?,~X NO, ~, [31 City of Camel~Clay Township APPLICATION FOR ELECTRICAL INSPECTION CONTRACTOR ZNFORMAT~ONI APPLZCANT ZNFORMATLON: TYPE of WORK: PROPERTY OWNER ~NFORMAT~ON: tINSPECTZON ~rN FORMAT]:ON: PHONE C~/ ~tate ZIp NA~E CONTA~ PHONE: Prope~ Owner V Contra~or (or agent) ~ _ OR Represen~ve RESIDEN~L:. COMHER~L: PROPER~ OWNER N~S): P~NE: ~ ADDRESS (INSP~ON ~ON): DATE OF ]NSPE~ON: ~HE OF [NSPE~ON: TYPE OF IMPROVEMENT: MOVING SERVZCE FROM OVERHEAD TO UNDERGROUND? C3 UPGRADE SERVICE: From to [] YES /~NO I~ UPGRADE PANEL BOARD(S) [AFCl BREAKERS REQU;[RED] Number of NEW CIRCULars: ~ C~ ADD~I'[ON, ALTERAT2ON, REMODEL, or REPAIR TO AN EX[5'T~NG ELECT~CAL DISTR[BUION SYSTEM Number of METERS; _ j _ KNEW METER SERVICE (I.e, Fountain in pond; I CERTIFY THAT THE INFORMA'I30N CONTA[NE~ / ' Subdivision sLTeet or slgnage lighting; Installation of ON THIS FORM IS COMPLETE AND ACCURATE, CONNECT~ON~eW utility services for an area) ~:~ _ -- 1 c-~ ROW S:[GNALi SENSOR, MONITOR (i.e, Traffic Light) STRUCTURE rr~. ~ % I DA'r~ _ COMMENTS or FURTHER LOCATION CLARZF[CATZON: (: ~ ~ '-- yJ' ~= --~ :i. _) lercial Inspections; $ 53.50 for Residential Inspections