HomeMy WebLinkAbout06040061 Application
City of Carmel/ Clay Township
j APPLICATION FOR ELECTRICAL INSPECTION
:p . ~ OQ?(
NAME
CONTRACTOR
INFORMATION:
Q
""'--
",01(') J~"o-J So ~ "-.
City
State
Zip
~
ell,
Street Address
~~ uN t::,~
NAME
APPLICANT
INFORMATION: Property Owner
(or agent)
TYPE of WORK:
/
RESIDENTIAL:
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
L::. 3~~;/~
STREET ADDRESS:
"lJw3
t-le
STREET ADDRESS (INSPECTION LOCATION):
INSPECTION "3 7
INFORMATION:
PHONE
FAX
;S 11--1;)1- oF?
-Jdr1(O
CONTACT PHONE:
Contractor
OR Representative ~
COMMERCIAL:
PHONE:
City State Zip
c.,Q . Lfl01/ e"- ,-;--,.j
City State Zip
DATE OF INSPECTION:q
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
~DmON, 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
I
TIME OF INSPECTION: I
/1) -
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
~O
DYES
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
OO-.L
J /es
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
fi~~ tn 1(: He;}/'V' ~ ~ T7~
~~ d eJ - T '10 ~/-HrJ f?L ,: Ie 6J
, c-Ho
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts(formsjElectrical Application Apr 2006