HomeMy WebLinkAbout06020136 Application
City of Carmel/Clay Township L/6'O.?\ 0/3-' I
APPLICATION FOR ELECTRI ~AL INSPECTION
NAME
CONTRACTOR
INFORMATION: Street Address
26t;~ r 1-J1-J5
City State .
Zip
NAME
APPLICANT
INFORMATION:
TYPE of WORK:
RESIDENTIAL:
PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
STREET ADDRESS:
La
. ~Z3
STREET ADDRESS (INSPECTION LOCATION):
INSPECTION 50 1t..1 e
INFORMATION:
DATE OF INSPECTION:
TYPE OF IMPROVEMENT: /
A e D Jar e e xrrhbrj; ) co ,4- )b /0<0
JlQ, UPGMDE SERVICE: From fJCO to J()n
~ 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
lj MD ,
CONTACT PHONE:
OR
'b67- LJS--
Contractor V .
Representative ~
COMMERCIAL:
PHONE:
City
5"8)-/
'fA)
'IfLJJ3
State
Zip
c/
City
State
Zip
TIME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
~ NO
()
Number of NEW CIRCUITS:
Number of METERS: I
INFORMATION CONTAINED
MPLET NO ACCURATE.,_( 11 '
-261/) h
~;r6
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
FEES: $ 96.25 for Commercial Inspections; $ 53.50 for Residential Inspections
S:Permits/Forms/Electrical Appllcatlon Oct 2003