HomeMy WebLinkAbout06100027 Application
City of Carmel/Clay Township ;;It- () b~ DO rJ-7 i
APPLICATION FOR ELECTRICAL INSPECTION
CONTRACTOR
INFORMATION:
NAME
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Street Address
PHONE
Zip
FAX
3
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3/7 - 'i8 7 - .).(,71
City
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NAME
APPLICANT
INFORMATION:
V,'/, a e of' LJ~-s -f C 14
./
RESIDENTIAL: /'
Property Owner
(or agent)
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
r e. VI, u..J'- L-k
De t_Jr:!/
STREET ADDRESS (INSPECTION LOCATION):
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City
Zip
STREET ~OORESS (INSPECT10N LOCATION):
/ ~ (p ~ofie
DATE OF INSPECTlON: / D _ j- _ D
TYPE OF IMPROVEMENT:
INSPECTION
INFORMATION:
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CONTACf PHONE:
Jo 11
OR
Contractor
Representative
COMMERCIAL:
PHONE:
3/7- 5-71- 3
I
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ZIp
City
State
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c
State
CaJMel
TIME OF INSPECTlON:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S) [AFeI BREAKERS REQUIRED]
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELEClRICAL DISTRIBUION SYSTEM
p\ NEW METER SERVICE (i.e. Fountain In pond;
Subdivision street or signage lighting; Instaliation of
!lew utility services for an are~)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTlON or RECONNECTlON TO A RELOCATED
STRUClURE
z
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
;zr'NO
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
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Signature
S Co II- /... Iio,l)/ e. /0- <(-()(
PRINT ' DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of inSDection location)
FEES:
Commercial Inspectio
S:Permlts/FormsjElectrlcar App 2003
,
,
; $ 52.00 for Residential Inspections