HomeMy WebLinkAbout06050119 Application
City of Carmel/Clay Township .#O~CJ50//o;
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APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
FAX
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CONTRACTOR
INFORMATION:
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Street Address
City
State
Zip)
APPLICANT
INFORMATION:
5'2- 'f ~ (~'-1"-' ~ Qrc1..<- S. ~ ~ ,\..: ~
NAME
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Property Owner
(or. agent)
OR
Contractor
Representative
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CONTACT PHONE:
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, TYPE of WORK: ,"v,,,, . RESIDENTIAL:"" --"'-'
. C::OMMERCIAL:
.--....
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PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
A..-~s\e \J-. \-. ~.1)~~& s"1:l..J
PHONE:
"S\I- 2-5'i. - 0)':>.3
DATE OF INSPE
City State Zip'
-::r-....~{)l~ . :1"",. 41.c.~'Z..~
City State Zip
lY. C~..,.rl ~.
STREET ADDRESS:
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STREET ADDRESS (INSPEmON LOCATION):
INSPECTION. q'b';3"G S",,,,,-,,^,,-.r I.-....\u=.s.
INFORMATION:
TIME OF INSPECTION:
\
TYPE OF IMPROVEMENT:
,
VING SERVICE FROM OVERHEAD
o UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
~O
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS: I
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELE YSTEM
~W METER SERV i.e. Fountain in pond;
Subdivision street or sign . '; lation of
new utility se~ices for an area)
Number of METERS:
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.... b ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
,
THE INFORMATION CONTAINED
S COMPLETE AND ACCURATE.
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$'-It-olrir
o CONNECTION or RECONNECTION TO A RELOCATED I
STRUCTURE PRINT DATE I
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COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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,
::iF-
FEES $ 100.00 f
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Commercial Inspections; $ 55.50 for Residential Inspections
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S:PermltsjForms/E
cation Apr 2006