HomeMy WebLinkAbout06030106 Application
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City of Carmel/Clay Township O/t;03Q/Ofo
APPLICA TION FOR ELECTRICAL INSPECTION
NAME
PHONE
FAX
CONTRACTOR
INFORMATION:
( 3/7 ~ 6.' - 7:)~
City
3/7./ ,f',(,:t-.1w,,--
State Zip
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f'__z,;-9
NAME
APPLICANT ,L.--b",,;/
INFORMATION: Property Owner
(or agent)
J"";?-j'7,,,-
Contractor ,<., "-"""'- /<.L 7""'&
Representative
v
OR
TYPE of WORK:
RESIDENTIAL:
COMMERCIAL: ~/v<:-;),~Ad7'
PROPERTY OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:
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STREET ADDRESS (INSPECTION LOCATION):
City
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City
State
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Zip
I La/
STREET ADDRESS (INSPECTION LOCATION):
State
Zip
INSPECTION
INFORMATION:
d_
TIME OF INSPECTION:
TYPE OF IMPROV
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
o NO
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
Number of NEW CIRCUITS:
@~
fJid 0
[6V
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of METERS:
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 COMPL~TE.
_~-dJ- C
'Slgnature
ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
C-,C6",,"/ c._ ~/7;T
PRINT
3-/./'/6
DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
j/jJllle.., ui/;"~7-
L~r"a./,.,d J/v-rJ<!- bU,P~7 )/d-<:- /)/ ;;b,>y /01. A/n-/'h or:' 6-: /5,r:t!L:;..r.
- >/1'7,/<-,,/ ;f:u.r /aL
F ES: $ 96.25 for Co
rcial Inspections; $ 53.50 for Residential Inspections
S:Permlts/Forms
2003