HomeMy WebLinkAbout06090097 Application
CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
INSPECTION
INFORMATION:
City of Carmel/Clay Township =1J:- OiJ;OC((JOCJ7
APPLICATION FOR ELECTRICAL INSPECTION
I
I
NAME
PHONE
FAX
MA-k ClecL;<:-
317-3?'i~O
Street Address
oty
L..J:~^~
State
Zip
:uJ
I.[?~~I
D.-
1i5
NAME
~O~~
CONTACT PHONE:
c~~ !J<-<-5>
<f
s /.., - if q 1- ?~ 5' ~
OR
Contractor
Representative
Property Owner
(or agent)
....- RESIDENTIAL:
COMMERCIAL: <t.,.
PROPERTY OWNER NAME(S):
PHONE:
Es-l,;..\ "- Pev. C rlAC.
STREET ADDRESS:
sl(-(;{,Cj-~ 0(;2
oty state
Zip
,
~ ~ b3 07
/L( 500 C (N('c..cc-
STREET ADDRESS (INSPECTION LOCATION):
.53 ~D 0( )'1"\ /(/1
DATE OF INSPECTION:
v'J5~J.ooCa.<"",!.1 :ftJ
City state
Zip
f.-Wo:5 C,J
c;'[/( c,,'~ 17tAJ
TIME OF INSPECTION:
TYPE OF IMPROVEMENT Call
OVING SERVICE FROM OVERHEAD .
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
~NO
o 'YES
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
I
Number of METERS:
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~
o ROW SIGNAL, SENSOR, MONITOR (i.e, Traffic Light)
ct;, IJ"", 1
i
;(') S<'p 0 ~
DATE '
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
PRINT
I
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
$ 100.00 for Commercia
spections; $ 55.50 for Residential Inspections