HomeMy WebLinkAbout19080112 ApplicationPERMIT # ) q 0 3-D ( (
CITY OF CARMEL
Application for Electrical Inspection
CONTRACTOR
INFORMATION:
NAME
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PHONE EMAIE
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E UPGRADE SERVICE: From IDD W e
ADDRESS
CITY STATE
ZIP
RELOCATION
UPGRADE PANEL BOARD(S)
Number' of NEW CIRCUITS:
APPLICANT
INFORMATION:
NAME
- ,;dj ;I
PHONE:
f - 35 _S� 22(0
ADDRESS
CITY STATE
DP
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TYPE of WORK:
RESIDENTIAL
$72.00 PER INSPECTION UZ
COMMERCIAL
$133.00 PER INSPECTION
❑
PROPERTY
OWNER
NAME
Loa i
PHONE:
0 - - 319 (o :10 q&2 9D
INFORMATION:
ADDRESS
W7 E I I +k S-},
CITY STATE
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Zip
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INSPECTION
ADDRESS
CITY STATE
IJP
INFORMATION:
-�3� I< I +h_ St
s S
(02 a
DATE OF INSPECTION:
TIME OF INSPECTION:
STRUCTURE
Da / a N / y3
9-11 ❑ 10-12 ❑
12-2 ❑ 2 4
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD TO
UNDERGROUNDS
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E UPGRADE SERVICE: From IDD W e
19'METER
YES ❑ NO 02
RELOCATION
UPGRADE PANEL BOARD(S)
Number' of NEW CIRCUITS:
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
Number of METERS:
AN EXISTING ELECTRICAL DISTRIBUTION 'SYSTEM
I CERTFY THAT THE INFORMATION CONTAINED ON THIS FORM IS
❑ NEW METER SERVICE 0.e. FourW in pond;
COMPLETE AND ACCURATE
Sub oymm street or sllyw I""; Nsta wm of new utft
servlcas for an area)
= �„�.ia
❑ R.O.W. SIGNAL, SENSOR, MONITOR p.e. TWo LIUM
TIRE
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CONNECTION or RECONNECTION TO A RELOCATED
(WDA M: �rttu�
PRINT DATE
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: