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PERMIT #
CITY OF CARMEL
Application for Electrical Inspection
CONTRACTOR NAME PHONE EMAIL
INFORMATION: Jefferson Electrical LLC 352-270-5228 David @ jeffersonelectricllc.c�
ADDRESS CITY STATE ZIP
2114 E Washington Street Indianapolis Indiana 46201
APPLICANT NAME PHONE:
INFORMATION: David Spoonemore 352-270-5228
ADDRESS CITY STATE ZIP
2114 E Washington Street Indianapolis Indiana 46201
TYPE of WORK: RESIDENTIAL COMMERCIAL
$72.00 PER INSPECTION O $133.00 PER INSPECTION ❑
PROPERTY NAME PHONE:
OWNER David Leazenby
INFORMATION: ADDRESS CIN STATE ZIP
664 2nd Avenue NE Carmel Indiana 46032
INSPECTION ADDRESS CITY STATE ZIP
INFORMATION: 664 2nd Avenue NE Carmel Indiana 46032
DATE OF INSPECTION: TIME OF INSPECTION:
/ / 9-11 ❑ 10-12 ❑ 12-2 ❑ 2-4 ❑
TYPE OF IMPROVEMENT:
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UPGRADE SERVICE: From to
METER RELOCATION
UPGRADE PANEL BOARD(S)
❑ ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN IXISTING ELECTRICAL DISTRIBUTION SYSTEM
❑ NEW METER SERVICE (i.e. Fourrtain 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)
MOVING SERVICE FROM OVERHEAD TO
UNDERGROUND?
YES ❑ NO O
Number of NEW CIRCUITS: 1
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED ON THIS FORM IS
COMPLETE AND ACCURATE.
O CONNECTION or RECONNECTION TO A RELOCATED D"�'� ��,aV��sM ��� f�y
STRUCTURE PR��`�T DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
Installation of a roof mounted solar array consisting of (30) 340W modules and (1) 10K Inverter