HomeMy WebLinkAbout19080106 ApplicationPermit # I GDS 0 10
CITY OF CARMEL
`VDIAKa Application for Electrical Inspection
TYPE OFIMPROVEMENT:
❑ UPGRADESERVICE: From to
❑ METER RELOCATION
UPGRADE PANEL BOARD(S)
ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUTION SYSTEM
❑ NEW METER SERVICE (i.e. Fountain in pond;
Sub�lvision street or signage lighting; Installation of new utility
services for an area)
❑ R.O.W. SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
❑ CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
MOVING SERVICE FROM OVERHEAD TO
UNDERGROUND?
YES ❑ NO
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED ON THIS FORM IS
COMPLETE AND ACCURATE.
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
NAME
PHONE
EMAIL
CONTRACTOR
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lC
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INFORMATION:
CONTRACTOR ADDRESS
CITY
STATE
ZIP
0s, C (I V0t0('V
L A)
(5H Z"W5
V 603 2 -
NAME
NAME
CONTACT PHONE:
APPLICANT
L— 3 G I lo i tI
6 G
L
?l ( 7 7« 2a
9f
INFORMATION:
APPLICANT ADDRESS
CITY
STATE
ZIP
TYPE OF WORK:
RESIDENTIAL
$71.00 PER INSPECTION
COMMERCIAL
PER INSPECTION
❑
$131.00
PROPERTY
PROPERTY OWNER NAME
PHONE:
6 or3 you
('7 70 00;5—
a;
`INFORMATION:
OWNER
A)6*
INFORMATION-
PROPERTY OWNER ADDRESS
CITY
STATE
ZIP
3
C�
MI6 a 3
INSPECTION ADDRESS
CITY
STATE
INSPECTION
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l
INFORMATION:
DATE OF INSPE,CTIO�N:
TIME
OF INSPECTION:
() / St(
9.11
❑
10-1212 -2
2.4Ln
TYPE OFIMPROVEMENT:
❑ UPGRADESERVICE: From to
❑ METER RELOCATION
UPGRADE PANEL BOARD(S)
ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUTION SYSTEM
❑ NEW METER SERVICE (i.e. Fountain in pond;
Sub�lvision street or signage lighting; Installation of new utility
services for an area)
❑ R.O.W. SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
❑ CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
MOVING SERVICE FROM OVERHEAD TO
UNDERGROUND?
YES ❑ NO
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED ON THIS FORM IS
COMPLETE AND ACCURATE.
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)