HomeMy WebLinkAbout06070123 Application
CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
INSPECTION
IN FORMATION:
City of Carmel! Clay Township
I
APPLICATION FOR ELECTRICAL INSPECTION
~ O(,;L3
NAME
M A k {(ah;e-
Street Address
Property Owner
(or agent) K
,. RESIDENTIAL: ~
PROPERTY OWNER NAME(S):
E'5+/~~
Pel!.
I
ZJp
/..((.10
I
Zip
,
L ?i'J 3;2,
r-
STREET ADDRESS:
oty State
Ce..c,",cl X,J
c~ State
(a.r<l'<e I -:Lfti
TIME OF INSPECTION:
(l-j
c- bot'
C
DATE OF INSPECTION: 0
TYPE OF IMPROVEMENT:
~ovb
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
~ NO
DYES
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of METERS:
.i.
I
I CERTIFY THAT THE INFORMATION CONTAINED
ON THI F IS COMPLETE AND ACCURATE.
4 'II - 7~ Sf, I
~
NEW MffiR SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
I
'20,\ ,/yOb
DATE
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
Signature
~O^..R..~" (/" ~fJnc5S
PRINT
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
L (A,{[ C< '" (r- j f- L : ... cJrII f ~ ; r ~ '
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/Forms/Electrlcal Application Apr 2006