HomeMy WebLinkAbout06060094 Application
CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
TYPE of WORK:.." ..-.
PROPERTY
OWNER
INFORMATION:
INSPECTION
INFORMATION:
City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
'Sc
PHONE
FAX
State
Zip
Street Address
Oty
NAME
CONTAcr PHONE:
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o
Property Owner
(or agent)
Contractor
Representative
L
OR
. RESIDENTIA~:'-X ...
."H COMMEROAL:.' ..." -- .... ,..
PROPERTY OWNER NAME(S):
PHONE:
. St->6.bEJ<:GtL
70 - 'J;) ()
Oty State
(2....~EL- IIN
City State
<2A-iZ-fl,1,6 L (N
STREET ADDRESS:
Zip
-4 "6 '3 ~
dJ. ( 1"51 Av6 NW
Zip
STREET ADDRESS (INSPEmON LOCATION):
. d-~[ ISf" .A:VG.. NvJ
-4"0'3 ;;L
DATE OF INSPECTION:
tHit> d:>.;)./,6
TYPE OF IMPROVEMENT:
~PGRADE SERVICE: From IDoA; to :;'",0),
TIME OF INSPECTION:
/1 - /;;?
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? :
DYES
~O
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of NEW CIRCUITS:
Number of METERS: ~
,
I CERTIFY THAT THE INFORMATION CONTAINED
ON TH FORM COMPLETE AND ACCURATE.
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utiiity services for an area)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
Signature
L~r..Jc.0.. Sr-J cDE.~
PRINT
~. /3,0(,
DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/Forms/Electrlcal Application Apr 2006