HomeMy WebLinkAbout060300126 Application
City of Carmel! Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
r!JC(!)30/d~f,
NAME
INSPECTION ~
INFORMATION: (
aLe1J
PHONE FAX
17-752- 7751. 317-769- ~6i ~5"
City State Zip
I
Zi f/6 t7 7.
CONTACT PHONE:
/7-7.52 - 77. 0'
Contractor
OR Representative I/'
COMMERCIAL: V
PHONE:
/7-63.7- - 'lfl 77 ,c)< S&'
State Zip
,
- .7# 1"62/:8
Oty State Zip
L-T
TIME OF INSPECTION:
,
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? I
I
0 YES 6' NO I
CONTRACTOR
INFORMATION: Street Address
/ s: <9 ^F#L
NAME
APPLICANT
INFORMATION:
TYPE of WORK:
RESIDENTIAL:
PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
eve/I
STREET ADDRESS (INSPECTION LOCATION):
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From to
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXIsTING ELECTRICAL DISTRIBUION SYSTEM
Number of NEW CIRCUITS:
Number of METERS: /
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TOA RELOCATED
STRUCTURE
I CERTIFY THAT THE INFORMATI
ON THIS FORM IS COMPLETE AN
jliQ NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
. new utility services for an area)
PRINT
COMMENT~THER LOCATION CLARIFICATION:
'!j;/ . Z / (f.1:..4.
I
I
(Please attach mao of insoection location)
, .
FEES: $ 96.25 for Commercial Inspections; $ 53.50 for Residential Inspections
S:PermltsjFormsjElectrlcaJ Application bct 2003