HomeMy WebLinkAbout06060091 Application
~,,-\ioi CAI1~
/ V ~1'.~,:rNFJ{f4. ~
/ " ! "'"
I - I
, I
\ ,
, '
\ ' /
~/"DIA"~/
-....;_._-,~-
City of Carmel/Clay Township '~f.eo~ lJ1)~1
APPLICATION FOR ELECTRICAL INSPECTION
/ '70 cr ZJ!) ()/ ..' 500~CD
CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
INSPECTION
INFORMATION:
NAME
~)o6 8ecL,c
Street Address
'Qg3?- 6~4!l-t.
LtlvYV'
NAME
W~k.
Property Owner
(or agent)
.. -RESmENTIAL:-' -'" ,..
PROPERlY OIj'NER NAME(S):
HeA -{.V...-t-v K", oil HoA
,
<-
STREET ADDRESS:
q~5/ Dei~ cd",'? Row
STREET ADDRESS (INSPECTION LOCATION):
1415'i? /-Ie~ (//LV!( J.
I{
DATE OF INSPECTION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~EW 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 (Le. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE,
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
~.wVI'~e. <9-n 6.:Lvl::- 0+ ~'1 lAJJQ I
c ,
PHONE
FAX
'311-7 J t,-fi b71j
'----.
City
/J o l,J.pf(l , 71e
State Zip
.L-,v
Yb06.0
CONTACT PHONE:
'3 /7- 71 6-8 6 7 ~
OR
Contractor
Representative V-'
COMMERCIAL: ._,~~.
PHONE' I
(s+eve 8vcev-""'"",,):
J - ~Ig ~2qoo I
,
City State Zip
Ad 'E!{S k(V Lf6 i ~ CJ
City State Zip
LtA V ~ -!/V Lj(,orz..
TIME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? I
DYES
o NO
Number of NEW CIRCUITS:
Number of METERS:
,
AT THE INFORMATION CONTAINED
RM IS COMPLETE AND ACCURATE.
I
/
r.if,
b
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/FormsjElectrical Application Apr 2006