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HomeMy WebLinkAbout06020096 Reciepts/Permits I \ '- City of Carmel/Clay Township oK t z{2.dtJ~ APPLICATION FOR ELECTRICAL INSPECTION 4t= CJ60c:?009 NAME CONTRACTOR INFORMATION: In/ / ;) c., liif AI/..t.. NAME APPLICANT S/e"tt)..lle;,/ INFORMATION: Property Owner (or agent) TYPE of WORK: RESIDENTIAL: PROPERTY OWNER NAME(S): PROPERTY ol~ OWNER INFORMATION: STREET ADDRESS: ~ INSPECTION INFORMATION: PHONE FAX 3i7- 'g<.f3 -0 b-77 3 - '8'-63("r City State Zip dlrm.u N Lfi' 3 ~ CONTACT PHONE: I - 71 o-ILfSq o UPGRADE SERVICE: From Contractor Y.. OR Representative COMMERCIAL: X PHONE: City State Zip "LN I..{ ft'033 State Zip ('1 :;J:N 'f ld B :A- TIME OF INSPECTION: TYPE OF IMPROVEMENT ~ OVING SERVICE FROM OVERHEAD o UNDERGROUND? DYES o NO o UPGRADE PANEL BOARD(S) [AFCI Number of NEW CIRCUITS: o ADDmON, ALTERATION, REMODEL, or REPAIR TO AN EXISTING ELECTRICAL DISTRIBUION SYSTEM ~NEW METER SERVICE (i.e. Fountain in pond; Subdivision street or signagelighting; Installation of new utility services for an area) Number of METERS: I CERTIFY THAT THE INFORMATION CONTAINED ON THIS FORM IS COMPLETE AND ACCURATE. o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light) Slgnature o CONNECTION or RECONNECTION TO A RELOCATED STRUCTURE PRINT DATE COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location) A iDOA 'MI ;;/Ol1VSU',,:Ct- <..<.J'j\\ 'Pe..\I's+r~i~Ji -f'ora..<;-{o'-"jl!.., bv-;/r/;"4 Iod,,:o/lc.C 'j' ". - '. 1,- .$u6-P NE:L I +112. I{Ul1 I f",~.-i<'D()n"-I1/),,dlsCVl E.4LAu:'f",Jn (!"",er. -il."., .<, L.., I.. . :'._~. L:nes '"/" \ ~c...bppH( o-IT "f.\-lv....)C;.J.:_, 'j :'i2.rd:U -\f, +ha. GJU.Lat:oo/l C""",,*,r, FEES: $ 96.25 for Commercial Inspections; $ 53.50 for Residential Inspections S:PermltsjForms/Electrical Application Oct 2003