HomeMy WebLinkAbout06020142 Application
City of Carmel! Clay Township
i APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
FAX
CONTRACTOR
INFORMATION:
Street Address
ELec-l-r, C''I. (t!:/f;-!err. f7tS€'! f~c. 7J'tY-22-7....-T 9#zz...-,.9
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NAME
APPLICANT
INFORMATION:
S~If>J-/2
TYPE of WORK:
Property Owner
(or agent)
RESIDENl1AL:~
PROPER1Y OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
~~ tNa.
STREET ADDRESS:
. 3 6 W ({ (JI,.JI'c./~.
STREET ADDRESS (INSPECTION LOCATION):
INSPECTION h 3 b WI {( 4 iN ,'e f<.
INFORMATION:
DATE OF INSPECTION:
TYPE OF IMPROVEMENT:
~PGRADE SERVICE: From/ll'u to Z-~.::>
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
o ADDmON, ALTERA110N, REMODEL, or REPAIR TO
AN EXISl1NG ELECTRICAL DISTRIBUION SYSTEM
o NEW METER SERVICE (Le. 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
OR
City State Zip:
I
If.,OtY'vJ N 7/62c;'J
CONTACT PHONE: I
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Contractor i
Representative ~
COMMERCIAL:
PHONE:
,pY.3 '7/9$
city
IN
State
Zlpt
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city
5"'6" t1 3 '2...-
State
Zip
'2.-. Q G
ro.-t- L ..Fill'" 6" t1 ~ 2-
l1ME OF INSPECTION: ').:0 Q ....:t.e;o
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
p\NO
Number of NEW CIRCUITS:
Number of METERS: I
/tI ...v-fl
I
:D4111t) l-,ST/e,tfCcf?.
PRINT
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AlE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
FEES: $ 96.25 for Commercial Inspections;
. S:Permlts/Forms/Electrical Application Oct 2003
r Residential Inspections