HomeMy WebLinkAbout06020030-Application
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City of Carmel! Clay Township. /' ZfG 11 /L/
APPLICATION FOR ELECTRICAL INSPECTION:
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NAM~
CONTRACTOR
INFORMATION:
V~17
c ON1l2..l~vTD12-:,
Street Address
APPLICANT
INFORMATION:
Po. '?10(P
NAME
i)PNe. J ~ SorJ
PHONE
.. 3)7, Lf<-fo. 12q8
City
State
WW1ieS~
'I1J
Property Owner
(or agent)
TYPE of WORK:
RESIDENTIAL:
CONTACT PHONE:
FAX
Zip .
l-f (p 01
~11. Lf-LfO. l~'i(
Contractor ~
Representative
OR
COMMERCIAL:
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S): PHONE:
K\C!c./f'.b.Y\O-.. ClcfYlenh '3>17. ~. "'2..~qe>
STREET ADDRESS:
GOL/-D .~. It G:, +---
STREET ADDRESS (INSPECTION LOCATION):
INSPECTION
INFORMATION:
0040 t::
110-1:s-
DATE OF INSPECTION: 2.... '9 . O~
TYPE OF IMPROVEMENT:
~ UPGRADE SERVICE: From lOoP-to ?-fJbk
~UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
. AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
City
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State
~
State
IN
Zip
%033
Zip
~3
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MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES /}!( NO
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Number of NEW CIRCUITS: UP 11) Lfo
U;j r-JS,
Number of METERS: i 8<\'STl/'J&
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
1< Fro /,/ c:f'
2,. g-. {)0
DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
S0~ N\ f'.1'l? ON N"0f'L!Tl-t s rot: or: 120 Pro
Jus, BfY~ K(\IC...-y< RbAD
City
01 Y1V' e../
TIME OF INSPECTION:
---_.~.-.-._._..~~--.....'"
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FEES: $ 96.25 for Commercial Inspect( nSi $ 53.50 for/Residential Inspections
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S:Permits{FormS{Electrical ApplicatIon Oct 2003 ~...:~.::..-__.-/