HomeMy WebLinkAbout06030016-Application
City of Carmel/Clay Township=!FO b 0300 / ~ I
APPLICATION FOR ELECTRICAL INSPECTION
I
I
CONTRACTOR
INFORMATION:
NAME
o /Yl jlJ i /:;echr I
PHONE
FAX
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765"-67S"'-57'i I
Street Address
oty
State Zlp
APPLICANT
INFORMATION: Property Owner
(or agent)
7:, l/&07Z-
CONTACT PHONE:
7/ Ca -,z9tJ3
OR
Contractor
Representative
TYPE of WORK:
RESIDENTIAL:
COMMERCIAL: V
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
L '5i'cY;rV {)eJ/~. ..I6\.b... Bcfb -;l()77
L:Jg~
PHONE:
/132
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State
Zlp
40D3
STREET ADDRESS:
:z;:J/
STREET ADDRESS (INSPECTlON LOCATION):
City
State
'Zip
INSPECTION
INFORMATION:
tfbiJ7f
TIMEOF NSPECTION:,4I'1'
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
TYPE OF IMPROVEMENT:'
o UPGRADE SERVICE: From to
DYES 0 NO
Number of NEW CIRCUITS: M
Number of METERS: /
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS ORM IS COMPLETE AND ACCURATE:
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
iE NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
,'5// J ()~
. 'DAn:
o ,ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COM ENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
'~cl_e..-o~ h .bJca1J d'n -do Nb ~- cJ ~;l1 '
FEES: $ 96.25 for Commercial Inspections; $ 53.50 for Residential Inspections
S;Permlts{Forms/Electrlcal Application Oct 2003