HomeMy WebLinkAbout06050225 Application
City of Carmel! Clay Township 4 () {; () S () -<! ;z5'"
APPLICATION FOR ELECTRICAL INSPECTION
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FAX I
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NAME
PHONE
CONTRACTOR
IN FORMATION:
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ct/7' 9'173
Street Address
S7Q(, ~k: 70rv e-1
NAME
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APPLICANT I c-
INFORMATION: Property Owner
(or agent)
JCJ-r~J
TYPE of. WORK: . - ..
City
State
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CONTA<;T PHONE:
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OR
Contractor /
Representative --v--
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PROPERTY OWNER NAME(S):
RESIDENTIAL:, - -.. . ...." "-"
PROPERTY
OWNER
INFORMATION:
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STREET ADDRESS:
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STREET ADDRESS (INSPECTION LOCATION):
INSPECTION
INFORMATION:
.17/
S7f'C~T
~ () 6
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DATE OF lliSPECITON:
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TYPE OF IMPROVEMENT:
d( UPGRADE SERVICE: From I Q)<J to J-- 00
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
o NEW METER SERVICE (i.e. Fountain in pond;
/"Subdivision street or signage lighting; Installation of
'n~w utility services for an area)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECITON or RECONNECITON TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
FEES: $ 100.00 for Commercial Inspection
S:PerrnltsjForins/Electrical Application Apr 2006
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PHONE:
, Cv..rI'lJ tJ
City State ZIPI
CCfi.(M.J ~
City State
~ 00 fIVL
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TO UNDERGROUND?
HEAD
DYES
YNO
Number of NEW CIRCUITS:
Number of METERS: ~
I CERTIFY THAT THE INFORMATION CONTAINED
ON HIS RM IS COMPL AND ACCURATE! .
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n3ar~
PRINT
(Please attach maD of insDection location)
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esidential Inspections
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