HomeMy WebLinkAbout06100029 Application
City of Carmel! Clay Township :fF D 6 (0 (f 0 ~ 1.
APPLICATION FOR ELECTRICAL INSPECTION
I
CONTRACTOR
INFORMATION:
NAME
/l
Ie Zlecf'l'~
Street Address
7 .33 &1&n.5A,/'C' L/e:.:./-e
NAME
APPLICANT
INFORMATION:
1/"(,4 e c.f LJc:'S t C 14-
Property Owner
(or agent)
V"
/'
TYPE of WORK:
RESIDENTIAL:
PROPERTY
OWNER
IN FORMATION:
PROPERT( OWNER NAME(S):
reV\w;Lk
Devel.
STREET ADDRESS (INSPECTlON LOCATION):
().. <8
1'04-& 5r/eef
State
STREET ADDRESS (INSPECTlON LOCATION):
PHONE
FAA
3 7"bl -(;,/1
317-f8'7,- .J,c'77
zip
c(~1237
City
../..'" c{ /s' J:-,
CONTACT PHONE:
-f () II
OR
Contractor
Representative
COMMERCIAL:
PHONE:
317- 6-7~- 3 DD
City
2
State
Ca-r'
:;::.,
City
DATE OF INSPECITON:
TIME OF INSPECITON:
INSPECTION / .3 DOe A
INFORMATION:
'/ C
TYPE OF IMPROVEMENT: 57/ -:))}tf1-
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 METER SERVICE (i.e, Fountain in pond;
Subdivision street or signage lighting; Installation of
!!-ew utility services for an arefl)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
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.
~c;t~
Signature
:J Co II- /.. /to.oj e. /0- <(-OG
PRINT ' DATE
o CONNECTION or RECONNECITON TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
00
--
~
FEES: $::9J:;59-,for Commercial Inspectio Si $ 52.00 for Residential Inspect:ions
. S:Perml armS/Electrical Application Oct 2003