HomeMy WebLinkAbout19080152 Application:tQTRA�,,, PERMIT #
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CITY OF CARMEL
No;pNp Application for Electrical Inspection
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CONTRACTOR
CONTRACTOR
NAME
PH NE
EMAIL
INFORMATION:
Q; a
311 S 31 -SS to
VYl
IL 113 tar.
ADDRESS
CITY
STATE
ZIP
i c)
Z 1S,
APPLICANT
NAMED 1 1
PHONE: tt
INFORMATION:
ADDRESS( i t
CITY
STATE
1 1 1 ZIP(I i T
TYPE Of WORK:
RESIDENTIAL
COMMERCIAL
$72.00 PER INSPECTION
$133.00 PER INSPECTION
PROPERTY
NAME
PHONE:
OWNER
INFORMATION:
ADDRESS
CITY
STATE
ZIP
18 �
cocmcl
X1 )
` 033
INSPECTION
ADDRESS
CITY
STATE
ZIP
INFORMATION:
DATEOF INSPECTION:
TIME OF INSPECTION:
/ p / ` 14
9-11 ❑ 10-12
O
12-2 ❑ 2-4 U
TYPE OF IMPROVEMENT:
OUPGRADE SERVICE: From to
METER RELOCATION
UPGRADE PANEL BOARD(S)
❑ ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUTION SYSTEM
O NEW METER SERVICE (.e. Fountain in pond;
Subdivision street or signage lighting; Installation of new utility
services for an area)
O 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 O
Number of NEW CIRCUITS:
Number of METERS: l
I CERTIFY THAT THE INFORMATION CONTAINED ON THIS FORM IS
COMPLETE AND ACCURATE.
C ��' !L:�2L"
SIGNATURE
{� 1
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach ma of f inspection locafion)