HomeMy WebLinkAbout06070008 Application
/-:-\-\QfC4~ ~
( "~''''Tts"",~,~ City of Carmell Clay Township ',If Itl) ~G
\ ~"" ) APPLICATION FOR ELECTRICAL INSPE~TION
''',[IIDIA>>~'/ <0
--' 000(1
NAME
PHONE FAX
3{ ~'1-
Oty State ZJp
IN
CONTACT PHONE:
.317- SZ
Contractor ~
OR Representative
COMMERGAL: V
PHONE:
31
Oly State ZJp
4(Pzr.
Oty Slate ZJp
~c..~ (~
TIME OF INSPECTION:
CONTRACTOR
INFORMATION: streetAddress
APPLICANT
INFORMATION: Property Owner
(or agent)
TYPE of WORK: RESIDENTIAL:
PROPERTY OWNER NAME(S):
STREET
PROPERTY
OWNER
INFORMATION:
'?::,r-
30 ~~
STREET ADORESS (INSPECTION LOCATION):
INSPECTION 1-0,
INFORMATION:
o UPGRADE SERVICE: From
to
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
~NO
DYES
TYPE OF IMPROVEMENT:
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
Number of NEW CIRCUITS:
Number of METERS: .:L-
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
, M"NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Instailation of
new utility services for an area)
I CERTIFY THAT THE INFORMATI N CONTAINED
ON THIS FORM IS CO PL AN ACCURATE.
c e. '-<--
52 r
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE '.,
Signature
- ~-x,
DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
/..tN<:...<)f-...I0~(12:c.- 5C{iS.7':>/v/s/orJ ~cI N(vJ ,c>.f rt{(ST/TowNel2.i::>
?o~ SlAF'Pt-y LA;s/Ne-r -FOil?... YJ6-flT~~ t!l4tSLE
I
FEE5: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/Forms/Electrical Application Apr 2006