HomeMy WebLinkAbout06060126 Application
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City of Carmel! Clay Township
, APPLICATION FOR LECTRICAL INSPECTION
002 C) ~
CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
, INSPECTION
I INFORMATION:
NAME
S', 1\(,\
PHONE
Can~~('u.J';0" J-nc. :Si7.'c)'i'l-OILU
City State
Street Address
r- ' 'y
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LiS
i/O
NAME
/lL J He c I id <: (~\'\ ( c.
Property Owner
(or agent)
. RESIDENTIAL: '
(-; c',' ''-eJ
Tf'I
CONTACT PHONE:
OR
') ," c,,: (f . C' 12..Co
...1 . L\ t'-t
Contractor
Representative ;(
COMMERCIAL: "
PROPERTY OWNER NAME(S): PHONE:
C leI C\c'-'. Sjl~()\~
FAX
.
I
.~/{ 8S(!i2./2.(
,
Zip
,II
'7 La Lf!O
State
2N~ '7'9((: /
STREET ADDRESS: City
STREET ADDRESS (INSPECTION LOCATION):
C''''^I C. )'> .s-+ s+: C'
~""U c .:. qr (;.
City
State
a
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 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
TN
c
"X/'J
Zip
. I..
,/(CC J:.S ..$
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
./
DYES 0 NO
Number of NEW CIRCUITS: I;
Number of METERS: I
,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORMrS -OMPLETE ANDUCCURATE.
111' (i , t-m c ) I . \.
\..e..V~O" )3. '\.. ,..<<.. .
Signature i
M i c...11(\( I A/! L c'rhcc
PRINT
7 - 2l\ --{:I(:,
DATE 1
COMMENTS or FURTHER LOCATION CLARIFICATION:
'?!t;/J Shh' -1- a -Ilack,)
. I
(Please attach maD of insDection locati6n)
i
I FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
L-
S:PermitsjForrnsjElcctrical Application Apr 2006