HomeMy WebLinkAbout06060124 Application
City of Carmel! Clay Township
/ APPLICATION FOR ELECTRICAL INSPECTION
LaO '70 I hi
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NAME
CONTRACTOR
INFORMATION:
S',
Ii,J
PHONE
Ca\'\s'~f'lLGti0n ....Lilc. .217-87'-61"1...0
City
Street Address
s(o..:s
c, .s
ilo
APPLICANT
INFORMATION:
NAME
/I-'\; J lcuJ ,tl~ c G \1 C L.
Property Owner
(or agent)
TYPE of WORK:
-RESIDENTIAl:-
PROPERTY _
OWNER
INFORMATION:
PROPERlY OWNER NAME(S):
C leI C\cuc Sjlo()\.~
STREET ADDRESS:
S.;zO E.' , 13, s:+ S+.
STREET ADDRESS (INSPECTION LOCATION):
INSPECTION 105
INFORMATION:
12(,:JffJ sf:
w,
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 DISTRIBUION SYSTEM
-~ NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or sign age lighting; Installation of
new utility services for an area)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTlON TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
rlCiIl ShF"} a .f!tuk)
FAX
State
.s/(. 8'i-(f~2./Z.i
zih
- I
'-/(9' clo
1
I
TI'i
CONTACT PHONE:
OR
:~I - sell{ -c>\2.o
Contractor
Representative 'I-
COMMERCIAL: :
PHONE:
gcj ~ - ~'9([ /
I
City State Zip
Car c. TN '/(c'o:s ls
I
City State Zip
Gume..! I
T. Yfo03 -
TIME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? I
DYES
o NO
Number of NEW CIRCUITS: I i
Number of METERS:
,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM ISfOMPLETE AND r'1'CCURATE)
711 ~J1:.~)'-m sdJtc,-- I
Signature _ I
fA ; (.J~ c. c~hcc 7 - 20 loG:>
PRINT DATE
(Please attach maD of insDection location)
\,.
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permits/Forms/Electrical Application Apr 2006