HomeMy WebLinkAbout06020050-Application
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City of Carmel! Clay Township .J: 000:( 00 5'0
APPLICATION FOR ELECTRICAL INSPECTION
CONTRACTOR
INFORMATION:
NAME) J
Hu-bbard
PHONE
FAX
IMG,
J, J7~Jj;(2-!bgO 3/7-1f:l.:J-1
'I
Street Address
G 77'-1,N, U.s, 3/
CIty State
vJh'r-l-dccYld. TN
Zip
L-fio / 'l '-f
NAME
CONTACT PHONE:
APPLICANT
INFORMATION:
.z / 7- 53 5 -I 9
Property Owner
(or agent)
OR
Contractor
Representative
L
~
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
RESIDENTIAL: COMMERCIAL:
P"iEMo;;ER NAME(11 CLVr:!? N CUr/ ~ if Q _ PH:tvVI'
STREET ADDRESS: City
STREET ADDRESS (INSPEmON LOCATION): City
INSPECTION S/LfLf E, q 6 +-'1 Sf
INFORMATION:
DATE OF INSPECTION: ::z 0&
~ TYPE OF IMPROVEMENT:
State
Zlpl
I
TIME OF INSPECTION:
-fl-M
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o YES ~. NO
Number of NEW CIRCUITS: ~
;& UPGRADE SERVICE: From4DO to boO
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of METERS:
o NEW METER 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 FORM IS COMPLETE AND ACCURATE,!
X
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
Signature
Kcclph LOY} eos1-ev
PRINT
;
,
I
~}./ /0 Y Of.p
DATE I
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
.]YLSpd7Jy -,-TEE - --+n -r;;/lov:J 1?-Pf(~-So,jICt-h' V(? -h ~+p
,
$ 96.25 for Co
ercial Inspections; $ 53.50 for Residential Inspections
S:Permits{Form