HomeMy WebLinkAbout06060119 Application
CONTRACTOR .
INFORMATION:
APPLICANT
INFORMATION:
TYPE of WORK:..
PROPERTY
OWNER
IN FORMATION:
INSPECTION "5<
INFORMATION:
City 'of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
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, City State
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Zip
FAX
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Street Address
5&,3,9 ). U 3 Llo
NAME
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Property Owner
(or agent)
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CQNTACf PHONE:
OR
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Contractor
Representative 'I
.... ....RESIDENTIAl:--. .
..' ........ COMMERCIAl:c...................
PROPERTY OWNER NAME(S):
C e-\ C~Cu. S,LhQ0\~
PHONE:
8<1</- 99(0 /
STREET ADDRESS:
State
Zip i
City
S~O 6. I? s+ sf. Car (/
STREET AODR~S \IN~~ES<TI2N1-0<;A110N).~, 0 'i5 t) City
<90( ftCJJJV~ IS'
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DATE OF INSPECTION: TIME OF INSPECTION:
TN
'1<0033
State
Zip r
I
i..U_o03~
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From to
DYES 0 NO
Number of NEW CIRCUITS: A
I
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO'
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~ NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
Number of METERS: 1
I
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS MPLET~D .a:C~RATE.
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
SIgnature
M;c...~L&hCc.
PRltIT
7- 2o-do
DATE
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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rot -Sc)fItY()! :z.OYL!2- P/as~ @ 16/AJrLL I-i~J
. de(17 ,
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/Forms/Electrlcal Application Apr 2006