HomeMy WebLinkAbout06050108 Application
CONTRACTOR
INFORMATION:
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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
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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
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57 (-I.Al-/-
if
TY~OF IMPROVEM~T:
u '~~
o UP D~ From to
MOVING SERVICE FRO
~~OUN9ERGROUND?
at YES . 0 NO
EAD
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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
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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)
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FEES: $ 100.00 for Commercial Inspection
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entia I Inspections
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S:Pennlts/FormS/Elecbical Application Apr 2006