HomeMy WebLinkAbout06050087 Application
City of Carmel/Clay Township -4f {)6 05 oog1
APPLICATION FOR ELECTRICAL INSPECTION
NAME
PHONE
FAX
CONTRACTOR
INFORMATION:
cl-c..&tJro (ot?
317-536-070'/
317- ~ ~I?' 071tJ
Street Address
City
State Zip,
APPLICANT
INFORMATION:
I 338 Sl'lt>>-lvl2. C 11lG/..6 f". lM..
NAME J
""B ILlbl-l IOL~J I (...T'! "'~ CI>.LI'tEL
Property Owner""'---
(or agent) OR
IN DIIlIlJAIoLI.5 ,'''
lJb;S'I
CONTACT PHONE:
317 - '1/7- 5tJ(. 3
Contractor
Representative
TYPE of WORK:" . "'. .
RESIDENTIAL:' . ..
... .... ... ..... ,...u. COMMERCIAL: ~......
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
C 1;'( or:: CAt."W~ ..
PHONE:
Il.ITle 5
317- 57/- ;[,'18'
STREET AODRESS:
City
State
Zip
IJO gr AII6 5W
CI/IU>16L
h.l
If €,()3~
STREET ADDRESS (INSPECTION LOCATION):
Oty
State
Zip
INSPECTION 31./50
INFORMATION:
-S;FIEI-/) 1M
TIME OF INSPECTION:
'1b071
TYPE OF 1M
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
o NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
Number of METERS: ~
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
. ~ NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMP ETE AND ACCURATE.
I
6-//-Ob1
DATE :
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
Signature
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
15eJtW S. 7;,UM/
PRINT
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
t.J6W (.oN~)TIl.l)c.-TlcJ.. /l,.{P,I.u <SWALU::!1 FAGt/..\'\''1
I, loCO A~? .. lit> /~tY( y 3~
mercial Inspections; $ 55.50 for Residential Inspections
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