HomeMy WebLinkAbout06060092 Application
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( .' ! ";. City of Carmel! Clay Township . It ()ft t>> 7fy
\ ~., r ) APPLICATION FOR ELECTRICAL INSPECTION
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CONTRACTOR
INFORMATION:
Street Address
I q <3'"3;2. Cvt-tk {<ct,
NAME
APPLICANT
INFORMATION:
LV'-vy W4b
Property Owner
(or agent)
TYPE of WORK:
.. ." -'RESIDENTIA~:-"
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):..
<S4""",,-fu v-JL 'r' OVV'
lfoA
STREET ADDRESS:
955" I pd., o.:ks r<.:nv
PHONE
~li-711:,-<J675'
FAX
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City
I\Jvb>Ir"5vIIle
State
Zip
IiU
'It oto
CONTACT PHONE:
~ n- 7/6 - 'g{,7J;
OR
Contractor
Representative ...,....--
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COMMERCIA~:" . -~ ___l
PHONE: {S-l~v~ 0.-0"",, ~~
"3 (7- l?1~- Z"70o
City
~of:
State Zip
<I\;,7 rAV L/{Z'-(O
~~ State Zip
J..,.,J '-(603z
,
TIME OF INSPECTION:
STREET ADDRESS (INSPECTION LOCATION): City
INSPECTION I ~ 3;;;1.. I G-oIJ~ &,de 1>~,\~ IPf7l-
INFORMATION:
DATE OF INSPECTION: .
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I CERTIFY T AT THE INFORMATION CONTAINED
ON THIS F M IS COMPLETE AND ACCURATE!
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o CONNECTION or RECONNECTION TO A RELOCATED Lwv V"'!a A , W~b 6ft 3/0b
STRUCTURE PRINT ( I DATE' I
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection loJtiOn)
th;/j ,,>t!-</vte-e ;~ ~ trn~ <<;-4,,~1 /,''? t-..:I-~ <n-->..e t'hf;cy-r,L
('I-rn-h",t!"K (f.ocJd d -5tJu::fI,(bu~f <'-&vVlo/'A- IJ+ "~d;/~J
("r 'L ,LV (
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
o ADDffiON, 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 (i.e. Traffic Light)
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? ,
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Number of NEW CIRCUITS: 2i
I
DYES
o NO
Number of METERS:
I
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FEES: $ 100. 0 for CommerciallnspectionSi $ 55.50 for Residential Inspections
S:Permlts/Forms/Electr1cal Application Apr 2006