HomeMy WebLinkAbout06100026 Application
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CityofCarmel/Clay Township if: 00/060:2.0
APPLICATION FOR ELECTRICAL INSPECTI6N
CONTRACTOR
INFORMATION:
NAME
/I Ie Elec 1-, ,'e
5treetAddress
PHONE
Zip
F,,^
3
3/7-f8'7- ).(,77
r".o ~toll
C~
7 ~3 01&,.,5ht/'e' L/u/-e J.-{/\ <I /$' J:,
NAME
APPLICANT
INFORMATION:
lJ,'1, 4 e ,,/, LJ.::-s -t C/4-
./
RESIDENTIAL: v/'
Property Owner
(or agent)
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
re~w;Lk
Devel
STREET ADDRESS (INSPECTION LOCATION):
I:A ~
1'0(1.j )i/eef
State
STREET ADDRESS (INSPECTION LOCATION):
INSPECTION
INFORMATION:
DATE OF INSPECTION:
TYPE OF IMPROVEMENT:
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 MffiR SERVICE (Le. Fountain in pond;
Subdivision street or signage lighting; Installation of
~w utility services for an arefl)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
c.(~IZ37
CONTACT PHONE:
-f () Ii
OR
Contractor
Representative
COMMERCIAL:
PHONE:
City
3/7- (;-7<(- 3 l)C
State ZIp
,
:;:::.
2
City
Zip
)7.
La. /' "" ~,j -T:--.
TIME OF INSPECTION.
~<6<:::l3L
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
%NO
Number of NEW CIRCUITS:
Number of METERS: I
2-
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
~ot~,
SIgnature i
S Co tI- I.. Iio "'/ e. /Q- r-O~
PRINT ' DATE '
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insoection 10~atiOn)
----
FEES:
r Commercial Inspections'
. ,
,
,
$ 52.00 for Residential Inspections
I