HomeMy WebLinkAbout06060125 Application
City of Carmel! Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
CONTRACTOR
INFORMATION:
S', lI,J
PHONE
CC)\"\5"~f'llGt0n -'-<1c .217--'0"1'1,6/<"'0
. City State
.?'I,- 8')<('2../2,(
'Zip
1)(O/!L/O
Street Address
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APPLICANT
INFORMATION:
NAME
/it ; J 1(1 (\ ItA c G- \'\ c c
Property Owner
(or agent)
TYPE of WORK:
'RESIDENTIAL:" '
FAX
G
TI'i
CONTACf PHQNE:
OR
:J,i ,fjc1(j; '('ILe.
Contractor
Representative j
COMMERCIAL: .'
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S): PHONE:
C e\ C\cu. SJh<)\~
fNc{- 99(0 I
State
'Zip
, I
'1(00:S .5
STREET ADDRESS: City
s~() IE, 12, sf S+. CU c
STREET ADDRESS (INSPEcrION LOCATION):
INSPECTION
INFORMATION:
w. /3[o/l1S+.
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
o ADDffiON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
7"f 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:
'?/(iJ! Shh' f a4ich",)
.
TN,'
City
State
Grl11eJ
TN
TIME OF INSPECTION:
,
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
o NO
Number of NEW CIRCUITS: I
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THI,S FORM!S -OMPLET E AND ACCURA "IE'
111 n }---m) n
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Slgna~re ,L ' ,_"'~ I
M i chur I .All c'rhc~c /- ZQ),o(o
PRINT DATE I
(Please attach maD of insDection lobatiOn)
I
I
j
I FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
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S:Permlts/Fcrms/Electrical Application Apr 2006