HomeMy WebLinkAbout06050120 Application
City of Carmel! Clay Township ~60 5 0/-;2(j
APPLICATION FOR ELECTRICAL INSPECTIONi
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CONTRACTOR
INFORMATION:
APPLICANT
IN FORMATION:
, TYPE of WORK:" .
PROPERTY
OWNER
INFORMATION:
INSPECTION
IN FORMATION:
NAME
PHONE
FAX
6-L"""f~lo...~'? 9.\Z:.<"'-\~h, Co, 1\1 *e~ l~r,
1\( 't'd 'f I ~o"l
State
Zip
Street Address City
:55'2-'-1- ~..J."'-'<Z-Ct,,,-~ s, s...A.';!: \3 ~l,
NAME
?;a JE-~NJ
Property Owner
(or agent)
'" "RESIDENTIAl::" . ,..
.::T..."
~'fl
CONTACT PHONE:
s\ "\ - '-l'tl't- \..{-o'G - ~ I- 2~5
OR
Contractor
Representative
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--. COMMERCIAl:: .-.-- '-,----
PROPERTY OWNER NAME(S):
A..J.o\-<-.-.I C>k ~, ~- 't.A\J,".ks",~
PHONE:
3\1-2.SQ-03e3
STREET ADDRESS:
Jc.;,'l-- G- Slo~ b.~
STRI'ET ADDRESS (INSPEmON LOCATION):
qrW S,_h.,,~l...UL~ \Of.
DATE OF INSPECTIO
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELE~ 6>IST.:~J~M
~W METER SERVI i.e. Fount' i ,_
Subdivision street or signage lighting; Installation of
new utility services for an area)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
City
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State
Zip
t...{&~
3:;.
City
Q,y~
State
Zip
f.W ..
TIME OF INSPECTION:
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MO ING SERVICE FROM OVERHEAD
UNDERGROUND?
DYES
~O
Number of NEW CIRCUITS:
,
{
Number of METERS:
HE INFORMATION CONTAINED
C PLETE AND ACCURATE. i
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PRINT DATE '
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(Please attach maD of insDection location)
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COMMENTS or FURTHER LOCATION CLARIFICATION:
ommercial Inspections; $ 55.50 for Residential Inspections
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S:Permlts/FormS/Electrical Application Apr 2006