HomeMy WebLinkAbout06040187 Application
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City of Carmel! Clay. Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
FAX
CONTRACTOR
INFORMATION: Street Address
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17-752-775'd 317-76'j- ~6!~-,
CIty State zip
I
.2A f/6Q 7
NAME
CONTACT PHONE:
APPLICANT
INFORMATION:
/7-75'2 -77.
OR
Contractor
Representative I/'
TYPE of WORK:
RESIDENTIAL:
COMMERCIAL: V
PROPERTY OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:
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17-632-';'tJ77~)< sll :
State Zip
- ~ .7# f/62~8
STREET ADDRESS (INSPECTION LOCATION):
City
State
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ZIp
I
INSPECTION
INFORMATION:
DATE OF INSPECTION:
,
TIME OF INSPECTION: Av '. ~
MOVING SERVICE FROM OV HEAD
TO UNDERGROUND?
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
DYES
.e:( NO
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
. Number of NEW CIRCUITS:
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of METERS: /
j)Q NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for a n area)
PRINT
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TOA RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach mao of insoection location)
7ol.0oC(2 ~Pf:>/, C*~I/I0ET Fop-- 1$R-(Gff-,Ho-cJ.~~
. ~ 'l, rCLr
,
FEES: $ 96.25 for Commercial Inspections; $ 53.50 for Residential Inspections'
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S:Permlts{Forms{Electrlca! Application Oct 2003