HomeMy WebLinkAbout06080089 Application
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(V~"'Trlt"'~) City of Carmel! Clay Township " ~~ cr-r
\ ',," ) APPLICATION FOR ELECTRICAL INSPECTION
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NAME -- I -? J PHONE FAX
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CONTRACTOR
INFORMATION: I
Street Address aty :ftJ;re Zip
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NAME CONTACf PHONE: G) s 'iI~ (c)
APPLICANT Alex: ?Dlo.J;{>..Y\ 511 '11<-/ -I i
INFORMATION: ~rty O~r Contractor I
(or agent) OR Representative
.. RESIDENTIAL: "" .\{ ;
TYPE of WORK: "",, I
0-'-- ,..,0 ...,--.' COMMERCIAL: ",,-, I
PROPERTY OWNER NAME(S): PHONE: (}II) '(-1<1 - I S' ~2.
PROPERTY Ak)( +>6\U-J;o..~
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OWNER ,
INFORMATION: STREET ADDRESS: City State ZIp
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37gv f. Dr 0\P1,)))
STREET ADDRESS (INSPECTlON LOCATION): City Slate Zip
INSPECTION 37~~ ~ ( (,.fM,e..\ 'Dr Cl.,r~( 11-1 4/;033
INFORMATION: DATE OF INSPE~~~ r ,v..\\ i
TIME OF INSPECTION: i
o UPGRADE SERVICE: From to
, .
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? I
o YES ~ NO .
Number of NEW CIRCUITS: -p-
Number of METERS: ~
TYPE OF IMPROVEMENT:
o UPGRADE PANEL BOARD(S)
~ ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
o NEW MffiR SERVICE (Le. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
~
Signature . . r
ALE,:( p{)L4D/4H :09/0~
PRINT ( DATE I
(Please attach maD of inSDection loc~tiOn)
I
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
FEES: $ 100.00 for Commercial Inspections,
r Residential Inspections
S:Permlts/Forrns/Electrlcal Application Apr 2006