HomeMy WebLinkAbout06040064 As Built
City of Carmel! Clay Township
! APPLICATION FOR ELECTRICAL INSKECTION
o 000 0 00 ,::rr-fJ O'i 0 OCsJ 1
NAME
PHONE
FAX
CONTRACTOR tJ l!~ WT (;" L.ECVZ;IC.
INFORMATION: Street Address
.;1.\01> O,",lO 1:;,"6
7b'-6'-1'J-~5Y
710> - "'i~- Lfr;;o
City
bV1)lO'/Z.So<f
State Zip
lAi
'f/;xjllo
NAME
CONTACT PHONE:
?/7.L{!7.,(){,3
. 70,)- (!.oB-I'i8J
13 e.,"" Tc>e<loJ - C.........."L
APPLICANT If.r;;ooJTA~T,*,,z: ~ - v <..eVT
INFORMATION: Property Owner
(or agent) ........ OR
Contractor
Representative
.........--
TYPE of WORK:
RESIDENTIAL:
. COMMERCIAL: ....---
PROPERTY OWNER NAME(S):
PHONE,
PROPERTY
OWNER
INFORMATION:
c.'T-' ot: c."'e....t;<..
STREET ADDRESS:
17. 7/- /)1,'18
City
State
Zip
136 IS' /wfj 51,<).
t:...t:lt...."'L
City
''"
'1/0032...
STREET ADDRESS (INSPECTION LOCATION):
State
Zip
INSPECTION
INFORMATION:
101005 \.\!lGeL DeLe 1>t\lU'W;lcf
DATE OF INSPECTION:
LJI.~a (Al
TIME OF INSPECTION:
'1bo 3
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
~
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
Number of NEW CIRCUITS:
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~W METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utiiity services for an area)
Number of METERS:
\
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND CURATE.
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
Signature
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach ma of ins ection location)
0.~l.{...l '-/r-O ~"t7 ,/t1t?4 FIL CITY"!: C/IJ-~<<" - fU...~O
<S e;l2-Ve;-o 13'--/ 1,::"}> l .
'if60-~7? t2 '{WAr. .....( '-loop.. SS 6J 7S?:JJ.fP 1'A-T1'L ~ (t> k. VA It! ~F,..d.. ~ 2tJJc/c::r-
~\,6.tl C;-:'T:~
PRI.rr
L( - 1'3.Db
DATE
FEES: $ 100.00 for Commercial Inspectionsi$ 55.50 for Residential Inspections
S:Permlts/FormsjEtectrlcal Application Apr 2006