HomeMy WebLinkAbout06080067 Application
City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
~ O~
NAME
PHONE
FAX
Oty
J'tf,;?- C7t7() ",-
State Zip
CONTRACTOR --,- /;;Le-cTnc-
INFORMATION: Street Add,ess
(' -/7
/"t3tf.
~
t,,, ~A~uY
COI'ITACT PHONE:
#,;:l5'!
NAME
APPLICANT t" ",'1" c.. n "7T
INFORMATION: Property Owner
(or agent)
(OR 3
(' 17 ?':;i'?7:r~
Contractor
Representative "t,:,,4",,-, ~7"r"6-
- TYPE of WORK: -. --- .... RESIDENTIA~:~""
... ., .. .-- .., . .-.. .GOMMERGIAl: ..X-'~-.
PROPERTY
OWNER
INFORMATION:
~l'&C
PHONE: L.t"o<. ,//6/ut- ~~",--~:2S
I
()!J I
S~re ~p
PROPERlY OWNER NAME(S):
j8t:, _C",,~-rAe'1" !1!/S"-'
STREET ADDRESS:
Oty
>I t.
Zip
q~28rY
INSPECTION
INFORMATION:
J't '1"
~(s
if:: ,,," c-
S~re ItJ
~rA-
TIME OF INSPECTION:
{;.t/ f'cJt. u ~",r I --t,. "1/m
MOVING SERVIC ROM OVERHEAD
TO UNDERGROUND?
STREET ADDRESS (INSPECTION LOCATION):
"
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
DYES
JzI' NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
o ADDmON, ALlERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of METERS:
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE A D ACCURAlE.
~.,~
J
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
ft CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE " .
Sign ture
C,L..6t"~;r c. ,/?-, ;rT
PRINT
!~-6&
ATE '
o
(Please attach maD of insDection location)
';/HA.r? hr7A1'~d~ I
. I I
COMMENTS or FURTHER LOCATION CLARIFICATION:
(10 hu'v~f E"n~r .:>-1 C6t-Lt'9t'- IOv<.--
S~ es~k ~ )()\1~
lXIVI' r;,~~T
I
I
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/Forms/Electrlcal Application Apr 2006