HomeMy WebLinkAbout06010157-Application
City of Carmel! Clay Township if=: 060 10757
APPLICATION FOR ELECTRICAL INSPECTION
TYPE OF IMPROVEMENT:
~PGRADE SERVICE: From :( 0 9
CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
INSPECTION
INFORMATION:
NAME
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o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
~DDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECfRICAL DISTRIBUION SYSTEM
~EW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
Street Address
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S. f/.,-r,{."
NAME
-
low.
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Property Owner
(or agent)
RESIDENTIAL:
PROPERTY OWNER NAME(S):
jV1"''1: r:.411:"
STREET ADDRESS:
/3 S <.(
I3Y!
DATE OF INSPECTION:
to
6QO
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCfURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
/3 5 'i J( c, 0/(> I .. IA "'-
,
,
~.
PHONE
FAX
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237 - 5 Co 13
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City State
flc,;"F-,:(cP Lit
Zip
it I'?
CONTACT PHONE:
OR
31 i) 7/' -'1'1'7('
/
COMMERCIAL: /
Contractor
Representative
PHONE:
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City
C<rr<<.d
City
Cqr.....
State
lip
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h.
State
Zip
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M
J TIME OF INSPECTION:
We. '
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
~O
DYES
Number of NEW CIRCUITS:
Number of METERS: ~
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS. FORM IS C~?E AND ACCURATE.
4~. .
Sfgnature
-.-
loA.,
PRINT
Sh'1W
/13/ 10(;
DATE
(Please attach map of inspection location)
R.d.
$ 53.50 for Residential Inspections