HomeMy WebLinkAbout06050118 Application
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City of Carmel/ Clay Township .00050 {, g
APPLICATION FOR ELECTRICAL INSPECTION
NAME PHONE
FAX I
'5\.1 - '-+0 'f-I'toct
CONTRACTOR
INFORMATION:
N\.~c.r~<>.d.. t:\~~1-<.. c~_ '3", '-\-6'-\--lQo'e,
Street Address City
J'524~r~,,-,\..... C.~rc-~ $.. S,,:~... q, ~l.j,
State
Zip
L/ll.-\{.f
~
APPLICANT
INFORMATION:
NAME
-r~~ JE.~W
CONTACf PHONE:
J\1- 4-'1:1'-4-1'-10'8 f2.,J.. 2X'S"
Property Owner
(or agent)
OR
Contractor ,/'
Representative .
. TYPE of WORK:"
. . RESIDENTIAL: ,.,
. V'
. '..." 'CO' COMMERCIAL:--'" .... .........:..:..- -.
PROPERTY
OWNER
INFORMATION:
PROPERlY OWNER NAME(S):
A/~s\E.'1IJ..\J~'-tJ....~,i~~~'N
PHONE:
")\1- 2'6"'1-03'8'3
STREET ADDRESS:
"$c.>~ € ~~.
City
-
J,.<,,).'t>P\.(.
State
./,"
""..... ..
Zip
t.f a:.z. z.o
o UPGRADE SERVICE: From
City
C -A.r....4
State
~.
Zip
STREET ADDRESS (INSPEcrION LOCATION):
INSPECTION l 0 C}q '3 S'<.l""""-~ I... \':II".
INFORMATION:
TIME OF INSPECTION:
I
MQ NG SERVICE FROM OVERHEAD
UNDERGROUND? I
DYES ~
TYPE OF IMPROVEMEN
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
I
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL TEM
~EW METER SERVICE ( .e. Fountai~ in pond;
Subdivision street or signa " ion of
new utility services for an area)
. Number of METERS:
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
,
AT THE INFORMATION CONTAINED
RM IS OMPLETE AND ACCURATE.
- .J~~l'N
"If-n-6<"
PRINT
DATE !
I
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
,
i
.1
I
,
mercial Inspections; $ 55,50 for Residential Inspections
,
S:PermltsjForm
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