HomeMy WebLinkAbout06100142 Application
I
I
City of Carmel! Clay Township tJh ) {}(j )~
APPLICATION FOR ELE~~L INSP~/ ~ON
CONTRACTOR
INFORMATION:
NAME
/l1,?ftJ4t:.L- IJ dmrrur
Street Address
APPLICANT
INFORMATION:
2311 r;-, 18Th ~ "
/J, J"'iTI.-C(
NAME
;J1ICllflEL
Property Owner X
(or agent)
TYPE of WORK:--,
"RESIDENTIAL:: -r ,-
PROPERlY OWNER NAME(S):
(1/'11 CI1 j4(j L A. <1m I TLE
PROPERTY
OWNER
INFORMATION:
STREET ADDRESS:
'231'1 F. - q r-,-Th ~1
STREET ADDRESS (INSPECTION LOCATION):
INSPECTION '2 37'1 (;, '1 p-~ ~
INFORMATION:
DATE OF INSPECITON:
TYPE OF IMPROVEMENT:
i;\1 UPGRADE SERVICE: From Jdo A to ?Ot! A
~ UPGRADE PANEL BOARD(S)
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
new utility services for an area)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECITON or RECONNECITON TO A RELOCATED
STRUCTURE _ _
PHONE
FAX
3'17-tJI(;-ZZ3 I
City State
/f'/f)'!1'fJAPDL-IS IN
Zip
'-16'280
, CONTACT PHONE:
91'Z-24() -811 f;
OR
Contractor
Representative
-- ,~-,;... COMMERGIAL:-- --...-". - -,-
PHONE:
612-7'-10-&/1'&
City State Zip;
/NOrftlJ/I{!{}L/S fA) 4&2~O
Oty State zlpj
I-iP '11N~ ~Ou s IN 4~'Z E3 0
TIME OF INSPECITON:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
~ YES
o NO
Number of NEW CIRCUITS:
Number of METERS: /
'-I()
,
I CERTIFY THAT THE INFORMATION CONTAINED
O;ilJ7I1~LETE AND ACCURATE.
Signature
/l1'C-IMB. /I. Im/ ,t.c)'
PRINT
I
16-/3-D'/o
DATE
I
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
If) IlP 0 rJ J) A LI'-..
----
FEES: $ 100.00 for'Commerciallnspecti ns; $ 55.50 for-Residential Inspections
,
5:Permlts/Forms/Electrlcal Application Apr 2006
qot-Vh s-
}~
'Ol
/1;
~
rJ
..
~
:sc
%-r"- ~1
06Q,yr
Q
'l:
~
>!
~
;::
V>
.'-,
:.
'"
:;;:
""
~
~
~
"
.\::
t.
~