HomeMy WebLinkAbout06050121 Application
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City of Carmel/Clay Township 06dS CJ /d:< )
APPLICATION FOR ELECTRICAL INSPECTION
CONTRACTOR
INFORMATION:
NAME
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PHONE
FAA
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Street Address
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State
Zip
APPLICANT
INFORMATION:
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NAME
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CONTACT PHONE:
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Property Owner
(or agent)
Contractor
OR Representative
TYPE of WORK: . .
-RESIDENTIAL:'
, .. .."..., ......." .. COMMERCIAL:,' ..."..... ....,...
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
Ac~S\e.\ ~'6\-" tJ---\)Jl\l~..J
PHONE:
STREET ADORESS:
10...>.... G- -5(.,kt- S-I;;-
City
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State Zip I
rC
:.J N . '-/l, 2-2-0
STREET ADORESS (INSPECTION LOCATION): City
INSPECTION qTs\ S'U.M.."".e.v- L.~\L.t.s ~j', C~~
INFORMATION:
State
lip <
o UPGRADE SERVICE: From to
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DATE OF INSPECTIO TIME OF INSPECTION:
/
TYPE OF IMPROVEMENT:
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
l
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o ADDmON, ALTERATION, REMODEL, or REPAIR TO
~STING ELECTRICAL or ION SYSTEM
NEW METER SER . ntain in pond'
Subdivision street or signage lighting; nstallation of
new utility services for a n a rea)
Number of METERS:
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
NFORMATION CONTAINED
PLETE AND ACCURATE,
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
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DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
ommerciallnspections; $ 55.50 for Residential Inspections
S:Permlts/Forms{EJe
001
2006