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HomeMy WebLinkAbout06050108 Application CONTRACTOR INFORMATION: , I I City of Carmel! Clay Township -qf" 0 h 0 so 10 8 APPLICATION FOR ELECTRICAL INSPECTION1 NAME PHONE FAX I ~ ~7bcJC6I~67^13:0L City Zip I '5/ M APPUCANT INFORMATION: <g?O:)Go~ OR Contractor Representative .,/' TYPE of WORK: ._- -~. .'RESIDENTIAl:. . ~. --.......... COMMERGAI.::.'. .... PROPERTY OWNER INFORMATION: . PROPERTY OW~R NA~ PHONE: INSPECTION INFORMATION: s,- "6 7- :3~;?L- State Zip; State Zip 1 1--0+ 6-1 113 TIME OF INSPECTIO I 57 (-I.Al-/- if TY~OF IMPROVEM~T: u '~~ o UP D~ From to MOVING SERVICE FRO ~~OUN9ERGROUND? at YES . 0 NO EAD I o UPGRADE PANEL BOARD(S) Number of NEW CIRCUITS: o ADDmON, ALTERATION, REMODEL, or REPAIR TO AN EXISTING ELECTRICAL DISTRIBUION SYSTEM Number of METERS: o NEW METER SERVICE (i.e. Fountain in pond; Subdivision street or signage lighting; Installation of new utility services for an area) ATION CONTAINED AND ACCURATE. i , I i , o ROW SIGNAL, SENSOR, MONITOR (Le. Traffic Light) o CONNECTION or RECONNECTION TO A RELOCATED STRUCTURE COMMENTS or FURTHER LOCATION CLARIFICATION: Signature I f)4f' (tJ If 5 fI f?4 C{ ~ ~ 0 It -ttb PRINT DATE (Please attach maD of insDection location) I I I I -'. FEES: $ 100.00 for Commercial Inspection I I entia I Inspections I S:Pennlts/FormS/Elecbical Application Apr 2006