HomeMy WebLinkAbout06070013 Application
City of Carmel! Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
. I
w'1001:1 i
NAME PHONE FAX
CONTRACTOR Ii, Ej'J....c... \ ~ c... 30-?f3S- ,/59..)-
INFORMATION: Street Address State ZJp
"65',},CJ JJ. ?SOW. 1\ iflo IJ.. /.q
NAME CONTACT PHONE:
APPLICANT
INFORMATION: Property Owner
(or agent)
Contractor
OR Representative
TYPE of WORK:... RESIDENTIAL:" 1/
... '0' COMMERCIAL:
PROPERTY OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:
Mcu- Ie. be ,-15(',H'I.
STREET ADDRESS:
City
State
ZJp
STREET ADDRESS (INSPECTION LOCATION):
tA,... el
City
L/ 3 "2.
Zip
I
I.jl"o:n
I
\')\oqO t- t'5W\ck. Blvd
State
INSPECTION i'~l,.,qD e..."e!;'w; cl t>\v&
INFORMATION:
DATE OF INSPECTION:
~I/'W\~ ~
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
,
D\NO
o UPGRADE PANEL BOARD(S)
flf ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRlBUION SYSTEM
Number of NEW CIRCUITS:
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM COMPLETE AND ACCURATE.
&JQ
~ 317-~3!J--'IS'9,j
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
Signature
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LO
?1:
Ko.,..A.Q \\ .s?,",II\U r
PRINT'
7- {;,-Olo
DATE
N: (Please attach maD of insDection location)
FEES: $ 100.00 for Commercial Inspection ; $ 55.50 fo Residential Inspections
S:Permlts/FormS/Electrlcal ApplicatIon Apr 200'6
......-.-.....---