HomeMy WebLinkAbout06050226 Application
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Ctty of Carmel/Clay Townshtp L '--.
APPLICATION FOR ELECTRICAL INSPECTION
CONTRACTOR
INFORMATION:
NAME - Je.c-+r-ic4J. Wo.ks PHONE
:no"BCVC( -{"(UJJl 317- 5')3~/007
FAX
J)1- 510-80/0
Street Address
(50192
City
fU(UI.f t+~ ct..
State Zip,
:b~ .#6'1?- :I (IJ 1;0D3 ~
NAME
CONTACf PHONE:
APPLICANT
INFORMATION:
Vf~ 11"'" ~ob.".so.->
Property Owner /.
(or agent)
3(7- '214<0 - .(.O.l3'
OR
Contractor
Representative
TYPE of WORK: .. -' ..".... ,RESIDENTIAI:::..<....V
...-.....-.. "E0MMERCIAI:::-
--~,....~,....
_; -..,o,;::::"..~
PROPERTY
OWNER
INFORMATION:
~J II
ob,,,.[;l>......
PHONE:
I
3(7.. ~4 - 4-o:i-
City
COlrD Iliv.., 1Iw-.
State Zip
::Ih .pt ~ .
'";;1:-"".
Ir 2~D
LOCATION):
INSPECTION
INFORMATION:
-
DATE OF INSPE
N:
TYPE OF IMPROVEMENT: I
,
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From to
f- UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
DYES
o NO
Number of NEW CIRCUITS:
Number of METERS:
...;/
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS CO LETE AND ACCURATE.
o NEW METER SERVICE (i.e. Fountain in pond;
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
1\o~+- ~ ?t'\OU( S;:3f-O~
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
-tUs-e.... fan L. ( 10 O'r-C-Ut-l- Iorea/c.& F';'}e-I
.,-
FEES: $ 100.00 for Commercial Inspections; $' 5.50 for Residential Inspect;io S
S:Permlts/Forms/Electrlcal Application Apr 2006