HomeMy WebLinkAbout19080166 ApplicationPerr it # l a 0 (o(*
City of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
TYPE OF IMPROVEMENT:
O UPGRADE SERVICE: From to
O METER RELOCATION
,❑,,1 UPGRADE PANEL BOARD(S)
xt,p ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUTION SYSTEM
O NEW METER SERVICE (i.e. Fountain in pond,-
Subdivislon street or signage lighting; Installation of
new utility services for an area)
O R.O.W. SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
O CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
D YES D NO
Number of NEW CIRCUITS:
Number of METERS: /
I CERTIFY THAT THE INFORMATION CONTAINED ON THIS
FORM IS COMPLETE AND ACCURATE.
SIGNATURE a
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
R£P1,ACAN6- ?oA1DAbtSTAL. 1CuA) o✓fk,BN CdnlSrkuGYan/CQ£(n%
FEES: $127.00 for Commercial Inspections; $70.00 for Residential Inspections
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NAME ({ PHONE
FAX
CONTRACTOR
{llt$S Lc,ct�lcAa LLL 3/7.83if-l9zz
Q4 -Z'04-587
q
INFORMATION:
ADDRESS
CITY
STATE
ZIP
/f
O IA-014A)APOGIS � S'rf.A
y
/ %000"4V(
lid
76�5�g
NAME 4+�'�"^'"`-� § { �
.Ci'Y / UT CT HON .
APPLICANT
(J /9 jbw
317-$3Zz
INFORMATION:
Property Owner
Contractor
(or agent) OR
Representative
TYPE of WORK:
RESIDENTIAL:
COMMERCIAL:
x
PROPERTY OWNER NAME(S):!(''
PHONE:
PROPERTY
A"7'
3/7-631-ZZ13
OWNER
LOM vA✓lr! .�AL11"s
INFORMATION:
STREET ADDRESS:
CITY
STATE
/, ZIP
4 1 C`. 94 -ra S -r, ST£ 7,215,
/" 1,0, 4.00 .lS
��
%/44
STREET ADDRESS (INSPECTION LOCATION):
CITY
STATE
ZIP
INSPECTION
I
3323 �Il£/ �3oRJi s /�itwY
�APiNEL
/
!�
�6a3Z
INFORMATION:
DATE OF INSPECTION: �_/ TIME OF INSPECTION: 9-11
10.12
12-2 2-4
TYPE OF IMPROVEMENT:
O UPGRADE SERVICE: From to
O METER RELOCATION
,❑,,1 UPGRADE PANEL BOARD(S)
xt,p ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUTION SYSTEM
O NEW METER SERVICE (i.e. Fountain in pond,-
Subdivislon street or signage lighting; Installation of
new utility services for an area)
O R.O.W. SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
O CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
D YES D NO
Number of NEW CIRCUITS:
Number of METERS: /
I CERTIFY THAT THE INFORMATION CONTAINED ON THIS
FORM IS COMPLETE AND ACCURATE.
SIGNATURE a
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
R£P1,ACAN6- ?oA1DAbtSTAL. 1CuA) o✓fk,BN CdnlSrkuGYan/CQ£(n%
FEES: $127.00 for Commercial Inspections; $70.00 for Residential Inspections
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