HomeMy WebLinkAbout06070118 Application
City of Carmell Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
/9
NAME
PHONE
FAX
CONTRACTOR e- ec_
INFORMATION: Street Address
3( 7117 - s-
Oly
State Zip
APPLICANT
INFORMATION: Property Owner
(or agent)
IN
CONTACf PHONE:
.317- sz.-
8
30
~-:,
A",
Contractor -L.
Representative
COMMEROAL: V
PHONE:
.31
Oly State ZJp
4(pzr.
Oly State ZJp
OR
TYPE of WORK:
RESIDENTIAL:
PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
J:sr-
STREET
STREET ADDRESS (INSPECl10N LOCATION): .
INSPECTION
INFORMATION:
TIME OF INSPECTION:
o UPGRADE SERVICE: From
to
MOVING SERVICE FROM OVERHeAD
TO UNDERGROUND?
~NO
DYES
TYPE OF IMPROVEMENT:
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
Number of NEW CIRCUITS:
Number of METERS: .!L.
I CERTIFY THAT THE IN FOR
ON THIS FORM IS COMPL
o ROW SIGNAL, SENSOR, MONITOR (Le. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE '.
AdlLW1 Miele' ~
PRINT
'tl2Ufor;,
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
i:t,w~f2 $UPFLY clt.~(,v€T ForIL ~P€.l(iff-Ttfo{)..~e
(&;jIoJ-ht-f Ad~ - 752- -(t)fir
FEE5: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:PermltsjFonTIS/Electrlcal Application Apr 2006