HomeMy WebLinkAbout06090167 Application
City of Carmel/ Clay -Township
APPLICATION FOR ELECTRICAL INSPECTION
- - a . I
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~ NEW MffiR SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
~OW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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CONTRACTOR
INFORMATION:
NAME TR A-fJ$ Tficlf /z(t'cfrfc.
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Street Address
I;)C7<.{ - f3((f-f-,.; R,t
NAME
APPLICANT C.JfrzlJTlkN b'u5T7,J
INFORMATION: Property Owner
(or agent)
TYPE of WORK:
.. RESIDENTIAL: .-.
PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
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STREET ADDRESS:
INSPECTION
INFORMATION:
STREET ADDRESS (INSPEcnON LOCATION):
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DATE OF INSPECTION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
PHONE FAX
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City State Zip
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CONTACT PHONE:
30- '531 -1</ b '/
OR
Contractor
Representative JL-
.. .., - COMMERCIAL:
PHONE:
Oty
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ZIp,
state
City
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State
Zip
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TIME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? I
!
,
DYES
Iji[ NO
Number of NEW CIRCUITS: 2
Number of METERS: ---L-
I CERTIFY THAT THE INFORMATION CONTAINED
/1;::FORM IS COMP~ND ACCURATE.
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PRINT DATE
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FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/FormsjElectrlca[ Application Apr 2006