HomeMy WebLinkAbout06060121 Application
City of Carmel! Clay Township .
APPLICA TION FOR ELECTRICAL INSPECTION
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NAME
CONTRACTOR
INFORMATION:
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PHONE
CDn$~(,LlLc\';0'" -'-1'1<:.-. :!'n-~)'i<(-6',-u
-City
:Slr- 8<7<( -2..12-;
Street Address
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ild
APPLICANT
INFORMATION:
NAME
"At J1C,cJ ,{A C-C';'\'lC c!
Property Owner
(or agent)
TYPE of WORK:
RESIDENTIAL: -
FAX
State
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CONTACT PHONE:
OR
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Contractor
Representative '/..
COMMERCIAL: .-
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S): PHONE:
C e\ C~~_ s2h()()\i
gc/~ - 99(() /
State
~Zlp
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-{(CO ~3
STREET ADDRESS: City
S~O G. 12. sf sf, Car c
STREET ADDRESS (INSPE010N LOCATION): .
INSPECTION ( .5 N. \ . er l(J
INFORMATION:
DATE OF INSPECTION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRlBUION SYSTEM
~ NEW METER SERVICE (I.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
7/cw ShF(~+ a-l!cILhe)
TN
City
State
Zip
0.rmc./ X
TIME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? '
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Number of NEW CIRCUITS: ,
DYES
o NO
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THI,S FORM ISf~PLETE AND ~CCURA~E.
122 ~Oc~ m cdJtLo.. I
S gnature ~
M ; cbU1 L 6-hc:c. 7- Z~-{]0
PRlf'ir DATE I
(Please attach maD of insDection lo~atiOn)
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S:Permits/Forms/Electrical Application Apr 2006
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections