HomeMy WebLinkAbout06100124 Application
City of Carmel/Clay Township ~ ~
APPLICATION FOR ELECTRICAL INSPECTI N
0-6 60Y I I
?J FAX.
'. . f3J) 'n))-Q17
, Zip
,
CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
. ...TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
INSPECTION
INFORMATION:
L.IC.W { (01l9100
NAME
ec'-5'otJ
Ie 5c(l}lce..
Street Address
:S71t 5(('- OfV ct:
NAME E/'"(..~r'I'CIq,fV
fA.! c,. it oM 0 wI'- -l r-
Property Owner ,,_
(or agent) --X OR
c
State
^-' 1/;,0 f)-
CONTAcr PHONE: L.t 3.5 - 00 ) .J "
"0'1'(- 30'1/ 0.,,,,,( /-10m J,".#-1.
Contractor
Representative
COMMERCIA!:::"""
. -..,.....-.. I.
I
7{03.2..
I Zip
1'6.9 J .2
PROPERTY OWNER NAME(S):
.. - 'RESIDENT-IAL:'-" .. -.. ..,,-
PHONE: 'i' '17
CafM /
STREET ADDRESS: Oly
IV
/360/ 5 IN<=.
STREET ADDRESS (INSPECTION LOCATION): City
6 {, (I
/0-/"6-0 eJ
DATE OF INSPECTION:
State
TYPE OF IMPROVEMENT:
X UPGRADE SERVICE: From f q Q to ") O@
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
State ZIp
;: ,00 -;Z 00 f".I\"l
TIME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
~NO
I
Number of NEW CIRCUITS: Q
Number of METERS: /
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE A D ACCURATE.
I
/o/,!;- 06
DATE '
);/cJ /l1cC/UN5
PRINT
COMMENTS or FURTHER LOCATION CLARIFICATION: {Please attach maD of insDection location}
FEES: $ 100.00 for Commerciallnspectionsi $ 55.50 for Residential Inspections
$: Permits/Forms/Electrical Application Apr 2006