HomeMy WebLinkAbout06090068 Application
City of Carmel! Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
fJ1)f.t
NAME
CONTRACTOR
INFORMATION:
16
APPUCANT /10
INFORMATION: Property Owner
(or agent)
TYPE of WORK: RESIDENTIAL:
PROPERTY OWNER NAME(S):
PROPERTY ;:Sf'
OWNER
INFORMATION: STREEf RESS:
30 ~""'
STREEf ADDRESS (INSPECTlON LOCATION):
INSPECTION ::Pl W 13~T#
INFORMATION: DATE OF INSPECTIONq
PHONE FAX
- 52- 3( ~7' S-
Oty State Zip
IN
.3/7 -
Contractor ~
OR Representative
COMMERGAL: V
PHONE:
Oty State Zip
aty State Zip
~ r,..J
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
,
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
~NO
DYES
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
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)
Number of NEW CIRCUITS:
Number of METERS: .:L
,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMP A D A RATE.
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
Q-14.10
DAlE I
I
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
.JdJII'1 polp..JfY 3Z> 15&? 3 ,I wf..e/-er fm.-$~ ~s, 01\ ~r,?h..+~r.{5k
fJoW€J" 'f>v.PP(t ~b,VlP-f- j/\e<rt:.f .fo fDle , !
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE '.
Signature
AdOfil fVl~-h~
PRINT
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/Forms/ElecbicaJ Application Apr 2006