HomeMy WebLinkAbout14070097 Application 'o�Y°F '4"�'\ Permit# � /�� 9!
/ �PTNRI�qy��� ��
j � City of Carmel/Clay Township
\�%NO AN /� APPLICATIOIV FOR ELECTRICAL INSPECTION
NAME
PHONE F�
CONTRACTOR =N , �� ��2i� � C 3 i�� yi3 o76a-�
INFORMATION: sc�ima,ess Gry s�e Z;P
/i�6 � OLD Fi��p p2 Ca2�e �w y�o33
NAME [pNTpC7pMONE:
APPLICANT /�"`�L L'���e� /N !�- � 31 7) y(3"�6 J 6
INFORMATION: p�oPem,Owner Contractor
(or agent) � � Is f entative �
TYPE of WORK: RESIDENTIAL: C ERCIAL:
PROPiRIY OWNER NAME(5): P
PROPERTY L��� l�i�� ' (l�
OWNER
INFORMATION: �TR ET^ooaess: �_ scace z�P
oZo/ N �r,ci� � ,�r,� �i�� ��/ �/6 0 302
STREET ADDRE55(INSPECTION LDCATION): Gry State 2ip
INSPECTION �� �J ��1� � �G/ C�L��.G� `r y �6 �j
INFORMATION: Z
DATE OF INSPECTION: 'a� /y TIME OF INSPECTION: /� _��m
TYPE OF IMPROVEMENTh MOVINGSERVICEFROM OVERIIEAD
TO UNDERGROUND?
O UPGRADE SERVICE: From �O to 9-� �
YES O NO
❑ UPGRADE PANEL BOARD(5)
Number of NEW CIRCUITS:
O ADDITION, ALTERATION,.REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM Number of METERS: �_
� NEW MtTER SERVICE(i.e. Fountain in pond; I CERTIFY THAT THE INFORMAITON CONTAINED
Subdivision street or signage lighdng; Installation oF ON THIS FORM IS COMPLETE AND ACCURATE.
new utiliry services fo�an area)
�;cP .L.�� ����'°�`�'�
❑ ROW SIGNAL� SENSOR� MONITOR(I.e. T2ffic Light) s�ynamre
O CONNECIION or RECONNECTION TO A RELOCATED I�`��G�i✓9'e'Q ��Zes��✓e�J 7 ���y
STRUCTURE P�T � onre
COMMENTS or FURTHER LOCATION CLARIPICATIONd (Please attach mao'of insoection location)
FEES: $ 115.00 for Commercial Inspections; $ 63.00 for Residential Inspections
5:\Pami[z�FdRMS�ACtive Forms Bindel(Copyable form Orginals)�AppllraHorts\2012 Bectriml Irtspection Applicadon.doc