HomeMy WebLinkAbout19080047 ApplicationPERMIT # 19 0100 YI
CITY OF CARMEL
Application for Electrical Inspection
CONTRACTOR
NAME
PHONE
EMAIL
INFORMATION:
-s
k
ADDRESS
CITY
STATE
ZIP
Ig18Qec�
pp
e eHri
Ty,
y l
APPLICANT
NAME
PHONE:
INFORMATION:
9:11
ADDRESS
CITY//
STATE
ZIP
14(e e., /' l;k
P
6f " —P' /
-1h
/
trOl V
TYPE Of WORK:
RESIDENTIAL
ga'*� COMMERCIAL
$72.00 PER INSPECTION
$133.00 PER INSPECTION
❑
PROPERTY
NAME
PHONE:
OWNER
Mcr n Bi-orl-
s33d�
INFORMATION:
ADDRESS
CITY
STATE
ZIP
10 4'f &4. wit
J,;
yz38b
INSPECTION
ADDRESS
City
STATE
ZIP
INFORMATION:
I d )yy gr
I/e - r
;7�1
6�bU
DATE OF INSPECTION:
TIM9 OF INSPECTION:
/ /9,00
9-11 ❑ 10-12
❑
12-2 D� 2-4 ❑
TYPE OF IMPROVEMENT:
❑ UPGRADE SERVICE: From to
❑/ METER RELOCATION
LJ UPGRADE PANEL BOARD(S)
❑ ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUTION SYSTEM
NEW METER SERVICE (.e. Fountain in pond;
Subdivision street or signage lighting; Installation of new utility
services for an area)
❑ R.O.W. SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
❑ CONNECTION or RECONNECTIONTO A RELOCATED
STRUCTURE
MOVING SERVICE FROM OVERHEAD TO
UNDERGROUND? ,
YES ❑ NO C�
Number of NEW CIRCUITS: 3o 3o
Number of METERS: r
I CERTIFY THAT THE INFORMATION CONTAINED ON THIS FORM IS
COMPLETE AND ACCURATE.
SIGNATURE
13r, lI 91h'fuh
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)