HomeMy WebLinkAbout06030205 Application
City of Carmel! Clay Township :::;to 6 03 c:; ~tJ5
APPLICATION FOR ELECTRICAL INSPECTION
NAME
CONTRACTOR
INFORMATION: .
K I J0td2-
G
Street Address
Di0lV6
NAME
APPLICANT
INFORMATION:
rB-J ?c1lV\ -r
J
v\
Property Owner
(or agent)
TYPE of WORK:
RESIDENTIAL:
. PROPERTY OWNER NAME(S):
PHONE
Fp:;.
30 - 'r::lf2 -DB
3n-8l(2-9~
City
State Zip
F{~
'1:N
i.{b 038
CONTACT PHONE:
31'7- 87S-'SLf2
OR
Contractor
Representative
COMMERGAL:
/
PHONE:
PROPERTY
OWNER
INFORMATION:
3 ('7-8r"J"'S ~sLf2-Lj
fAJ-""'!5f b ~ - City State Zlp
PLA?i1 ~ 2lo.I0SV/UE -:eAl
STREET ADDRESS (INSPECTION LOCATION): 1AJef5/lYZ- _ City State Zlp
INSPECTION 47$0 AJ[1l::FJi ~ . 2..!D)...)SVIU13 'LN
INFORMATION:
1&10 Po).JV\ -rR--
STREET ADDRESS:
Lf '6 0 1VGR:r1l'
TYPE OF IMPROVEMENT:
DYES
TIME OF INSPECTION:
(APb ""
o UPGRADE SERVICE: From I ZOO to 2.J:;Ci:) I -, 5:>:>/\ ~
MOVING SERVICE FRO OVERHEAD
TO UNDERGROUND? 10 -/ ?...
rn!'NO
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
d 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
Number of NEW CIRCUITS:
I-G'J-.\75rlJ0(,...
Number of METERS: I - fJC::vJ
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
~^' Q.,~
Sign re '
cr~ A -C41U2-
PRINT
3L3Dlo~
DA '
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
r Commercial Inspections; $ 53.50 for Residential InspectIons