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