HomeMy WebLinkAbout06090098 Application
City of Carmel/Clay Township kO~oq()O ge I
APPLICATION FOR ELECTRICAL INSPECTION
I
NAME
PHONE
FAX
CONTRACTOR
INFORMATION: Street Address
55 ()~ c;pe<~,^'{ ])
'51{-n'T3"{{i
oty
rIA.):.,,,,,, 0 I;;
State
Zip
Llb~LIY
'IN
APPLICANT
INFORMATION:
NAME
~O^~~"I
Property Owner
. (or agent)
CONTACT PHONE:
Cl:, \ J <'€- U
~
'3t( - ~('" , - 7 '15?
~ I)-/A~-'W/)
OR
Contractor
Representative
TYPE of WORK:
," RESIDENTIAL:"
- '.' COMMERCIAL: ~,
PROPERlY OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:
< .
:'((-~''t-7~10l
STREET ADDRESS: City
I ~'3f)u 0", T~a,,(.... is/vJ5IoPDL<>r V'"\€ I
State
ZJp
'1(,0:>.2.
TN
STREET ADDRESS (INSPECllON LOCATION):
INSPECTION 5':SLJ I b<c~~);.' n~1 C; rL Ie
INFORMATION:
Oty
C./I'''< I
State
Zip
:ffl/
'-1'05 DL
DATE OF INSPECITON:
TIME OF INSPECITON:
TYPE OF IMPROVEMENT CoIl 57/- ;;<tftfLf
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From to
DYES
f NO
o UPGRADE PANEL BOARD(S)
J l ~ ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of NEW CIRCUITS:
Number of METERS:
I
~ NEW METER SERVICE (i.e. Foun
Subdivision street or signa Ilghtin'
new utility services for an
I CER'~~~~~;HE ,INFORMATION CONTAINED
ON TH S ~~ COMPLETE AND ACCURATE.
Slg~rre
~A~~^ A (t,;,ld<e{1 'J.'()~_6'oG.
PRINT DATE
ond;
nstallation of
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECITON or RECONNECITON TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
al Application Apr 2006
$ 100.00 for Commercial nspections; $ 55.50 for Residential Inspections
,