HomeMy WebLinkAbout06070128 Application
/
CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
I TYPE of WORK:
I
PROPERTY
OWNER
INFORMATION:
INSPECTION
INFORMATION:
City of Carmel/ Clay Township
, APPLICATION FOR ELECTRICAL INSPECTION
6&0701ZS
NAME
S', n,J
PHONE
CDns'~(,\..lct0n ....LnL. JJ7-8"t<,o/?-U
City State
Zip
FAX
.~/{ ," 8'7(( 21Li
Street Address
5(03.9 (J. Lt s
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NAME
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CONTACT PHONE:
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Property Owner
(or agent)
Contractor
Representative '.I
OR
'RESIDENTIAL:,"
COMMERCIAL:'"
PROPERTf OWNER NAME(S):
C ') e, \ C\ C',L S L\h.) \~
PHONE:
zH ~ - 99((; /
STREET ADDRESS:
Zip
I
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{I"....... '--'
City
State
c:: '" ^ I r I" sf S',+,
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Cu (:
City
TN
STREET ADDRESS (INSPECTION LOCATION):
State
Zip
(nos'Z..
DATE OF INSPECTION:
TIME OF INSPECTION:
i
,
MOVING SERVICE FROM OVERHEAD
, ,
TO UNDERGROUND? I
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
DYES
o NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
!
Number of METERS: ,
j
,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM ISfOMPLET, E AND ACCURAT,E.
7J1 ~j)'-o,-J,)-m ~dJL ''- -'
Signature 1
M ; cl1Clc I ,A/I c C~hcc. 7 - zb-{)(.;,
PRINT DATE]
(Please attach maD of insDection lobatiOn)
I
I
~ NEW METER SERVICE (Le. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utiiity services for an a rea) .
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE :
COMMENTS or FURTHER LOCATION CLARIFICATION:
?/c;/J ShF<, f a.JIzlck)
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:PermltsjForms/Electrlcal Application Apr 2006