HomeMy WebLinkAbout06050006 Application
City of Carmel/Clay Township =#= 0 (,Oscn:::(P
APPLICATION FOR ELECTRICAL INSPECTION:
NAME
PHONE
FAX
CONTRACTOR
INFORMATION: Street Address
; k <:.....<v-o+- 1n- ''''51' '-I3"S-
City
3'1- 71..'j'SSn
State Zip
o .\-\0\.
Sl--...,.....A""-.
J-~
I..( (,,6lo't
.2.13- ';-,'/7-
;Lo/- <{';"1(,
NAME
CONTACT PHONE:
APPLICANT
INFORMATION:
]""Q.",,,;~ .,,+h
Property Owner
(or agent) D~""{ 10l.-; ~ OR
- -Co..-\-1uA.....
RESIDENTIAL: -' ""J./. ".' ''',,'' LCOMMERCIAL:
TYPE of WORK:.
~
PROPERTY OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:
..." : k .~ V\.+-\-s
3/1-57-3- 02.111
STREET ADDRESS:
City
State
Zip
s\{o vJ~s.\-- SW\..C
STREET ADDRESS (INSPEcrJON LOCATION):
INSPECTION t s tv>'>\.L- (L., <Lb"J'--
INFORMATION:
V0.NJ r2L. t-fJA
~
<-\ 100;' L-
City
State
Zip
DATE OF INSPECTIO
::::;:;;--
MOVING SERVICE FR
TO UNDERGROUND?
TYPE OF IMPROVEMENT:
~ ~
[y/(JPGRADE SERVICE: From hO to .;loo
~PGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
~DDmON, ALTERATION, REMODEL, or REPAIR TO
)N EXISTING ElECTRrCAL DISTRIBUION SYSTEM
~NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
DYES
C?"NO
Number of NEW CIRCUITS: ~
Number of METERS:
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
Signatur
o CONNECTION or RECONNECTION TO A RELOCATED
STRUcrURE
PRINT
DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
W <l:.S\- ,," 13b 0'- '3 ,",,0 ~ ien.u leA I <l.s+- ho ,^-SL 0"'- 1'1(,.-1-- h. .,; ~u..
"1 1310 /o.L~ dILL 31 . hnuSL ku. h.e"s.. (".-<1' '01'\. e...)(~'.,,",-
Or C'L\\ d-<,,- 4("C1b ~ ~. '''\, l-o":.+-.
. FEES: $ 100.00 or Commercial Inspections; $ 55.50 for Residential Inspections.