HomeMy WebLinkAbout06030029-Application
r;
City of Carmel/ Clay Township ~ 0 fo 0300 ;(0
APPLICATION FOR ELECTRICAL INSPECTIO"N
NAME
PHONE
FJ>j(
"517)-;>/-7 Z9
CONTRACTOR
INFORMATION: Street Address
12.-5&
C LG-f'r f<-,J I €:W LtJ '
NAME
APPLICANT
INFORMATION:
!:/..'" C12
c
Property Owner
(or agent)
TYPE of WORK:
~.
RESIDENTIAL:
PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
\111/\
STREET ADDRESS:
127:>1.1
STREET ADDRESS (INSPECTION LOCATION):
INSPECTION
INFORMATION:
TYPE OF IMPROVE
o UPGRADE SERVICE: From
o UPGRADE PANEL.BOARD(S) [AFCI BREAKERS REQUIRED]
~mON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage iighting; Installation of
new utiiity services for anarea)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
City
Zip
State
CONTACT PHONE: .
Contractor
OR Representative
COMMERCIAL:
PHONE:
City State Zip
l-Vf> CAR 0>2-
City State zip
TIME OF INSPECTION:
MOVING SERVICE FROM OVERHI;AD
TO UNDERGROUND?
~ NO ?
Number of NEW CIRCUITS:
DYES
Number of. ETERS:
I /
I CERTIPI!THAT/T.1:E.: NFORMATION CONTAINED
ON TH~SjFORMtIS C lLETE AND ACCURATE'I .
~II . .
Sign_re~ _. ,i
Dltr' (ji-A 14 3/~ 1""0
PRINT ~ATE
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insoection location)
Ke.plttCi~ WI')":) ctOW\O.Jod VJj IldVltVlI:J ;:,~k:~ ~ ~ .
~~
/
FEES: $ 96.25 for Commercial Inspections/ $ 53.50 far ~esidential Inspections
S:Permlts/Forms{Electrlcal Application Oct 2003
/