HomeMy WebLinkAbout14060115 Application „t:�aF cA M Permit# _/y06 0// �
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` - � City of Carmel/Clay Township
�. �.�" F� � APPLICATION F�R ELECTRICAL 1NSPECTION
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NAME VHONE �_I� O �jJ� S �6 � �
CONTRACTOR
�W �DL� (`1�(: ECE��(G ° � -
INFORMATION: saeetnadress c�ri swre �a
1,� �( (d' �A-G(� E � �rs�t,e rs (c� �l�Go 3d'
NAME CONTACf PHONE:
`��eFe �'o�� M�e a s�� - �P�g7
APPLICANT C -1 - 3� �9
INFORMATION: property Owner Contractor /
(or agent) OR Representative �
TYPE of WORK: RESIDENTIAL: COMMERQAL: �
PROPER7Y OWNER NAME(5): PHONE:
PROPERTY �a� w��l �acfs �5 53 a� - 3R 7�
OWNER state Z�p
INFORMATION: �E�rAOOaess: �G� ^/
6 �f S� � (3� � �,,,�.�. (�/ ��033
57REEf ADDRE55(INSPECIION LOCATIO�: C9ty Statr Z�P
iNSaecTZON �p ��� � � �� ���� _� e C � A/ �f o 3 Z
INFORMATION: -
DATE OF INSPECTION: TIME OF INSPECTION:
TYPE OF IMPROVEMENT: � VING SERViCE FROM OVERHEAD
T UNDERGROUND?
�UPGRADE SERVICE: From '�Vd to YES �NO
�UPGRADE PANEL BOARD(5) Number of NEW CIRCUIfS: �� �
O ADD1lION, ALTERATION, REMODEL, or REPAIR TO (
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM Number of METERS:
O NEW METER SERVICE (i.e. Fountain in pond; I CERTIFY THAT THE INFORMATION CONTAINED
Subdivision street or signage lighting; Installatwn of �N TNIS FORM IS COMPLETE AND ACCURATE.
new utility services for an area) �� C��'C.��
O ROW SIGNAL, SENSOR, MONITOR(i.e.Tra�c Light) s�gnamre
� CONNECTION or RECONNECTION TO A RELOCATED �e�� ���M�� �' (7E r
Pwrrr w•TE
STRUCTURE
COMMENTS or FUR7HER LOCATION CLARIFICATION: (Please attach map of insoection location)
�,t/o �aG� 3�F�Q� aEe�E ��o ��'�ru„e I �lew P�fia_►'T_.�(�aol
FEES: $ � for Commercial Inspections; $ 6�80 for Residential Inspections
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