HomeMy WebLinkAbout06020096 Reciepts/Permits
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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)
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'j' ". - '. 1,- .$u6-P NE:L I
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FEES: $ 96.25 for Commercial Inspections; $ 53.50 for Residential Inspections
S:PermltsjForms/Electrical Application Oct 2003