HomeMy WebLinkAbout06030015-Application
(/"~'''T7~'''''<<'~ City of Carmel/Clay Township #- 06tJ300 /~
, 'f,' ,/ APPLICATION FOR ELECTRICAL INSPECTION
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CONTRACTOR
INFORMATION:
NAME .
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PHONE
FAX
16S -61<(; -Wi./3
7bS:67r;-- 399/
Street Address
City
State Zip
APPLICANT .
INFORMATION:
:2b CJ1 S. 300 WI,"
NAME M51or/ 75eJ. UJ, .:Hvc-
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CONTACT PHONE:
. 7/(0 -z 993
Property Owner
(or agent)
v
OR
Contractor
Representative
TYPE of WORK:
RESIDENTIAL:
COMMERCIAL:
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
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PHONE:
81b-loI7.
STRE;;3Zs: S,~ ~fJ ~
State
Zip
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INSPECTION
INFORMATION:
STREET ADDRESS (INSPECT10N LO ON):
Lj/2-8 Uo//tIJ W
City
State
Zip
TIME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
o NO
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
. Number of NEW CIRCUITS:
2-
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECfRICAL DISTRIBUION SYSTEM
Number of METERS:
I
fIJ.. NEW MffiR SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility serviCes for an area)
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS F RM IS COMPLETE AND ACCURATE.
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A.RELOCATED
STRUCTURE
ture
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PRINT
3/1/ ()e,
rfATE '
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
rQ~t.JJ .Jo --to c-oYsd tf;b 2:0-0<J-'i l-01-c.f7
FEES: $ 96.25 for Commercial Inspections; $ 53.50 for Residential Inspections
S:Permlts{Forms{Electrical Application Oct 2003