HomeMy WebLinkAbout06110053 Application
NOV-02-2006 THU 11:37 AM
CONTRACTOR
INFORMATION:
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Ci of Carmel/Clay Townsh( ~~ .
APPLICATION FOR ELECTRICALmSPECTION
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FAX NO,
~
NAME
PHONE
FAX
'? \.\. Cor(~.\-~I"v~j L 111-"(,'39-2.<0'\\ "3,
'Jt7 9:.37-'1z...I/
street Address
CIty
~MNR~ I,!
state . ZIp
2, (,,0 8"PlS-t- 1\1,"""", ~-\-.
.:1 N '"'I ~ !ro '?
NAMe
CONTAcr PHONE:
317- In 9 -7-(., IS 5"
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APPLICANT
INFORMATION: Property Owner
(or agent)
STll.EET ADDRESS (INSPS:TlON LOCATION):
1'2.1L{7... U~\.t"", &~sl
DATE OF INSPECTION: \ 1-11~ olo
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From &:>D to (.Db
o UPGRADE PANEL BOARD(S)
~ ADDmON, Al TERA nON, REMODEL, or REPAIR TO
/"--.. AN EXISTING ELECTRICAL DISTRIBUJON SYSTEM
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
INSPECTION
INFORMATION:
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Contractor
Representative
OR
RESIDENTIAL:
COMMERCIAL:
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PROPEI<TY OWNER NAME(S):
Dvlk ~\\
PHONE:
(Au,..)
":)11- "(,60' "'DOD
ow
stale
ZIp
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STREET AOORESS:
{.,oo I.Z . q(., -\'I. S~,,+
:rc--J
:To"& ~.
CIty
'i3u D
yc,osc
State
ZJp
(Arl..M€:L .T r-J
TIME OF INSPECTION:
12-,00
MOVlNG SERVlCE FROM OVERHEAD
TO UNDERGROUND?
DYES
~NO
I
Number of NEW CIRCUITS:
Number of METERS:
o NEW METER SERVICE (I.e. fountain In pond; 1 CERTIFY THAT THE INFORMATION CONTAINED
Subdivision street or slgnage lighting; Installation of ON THIS FORM IS COMPLETE AND ACCURATE.
new utility services for an area) ~ ~ I
.~7-~3'l-Z(,,'\SS .
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic light) 51gnatu
o CONNECTION or RECONNECTIONTO A RELOCATED fA...,j ~MM1VL~i'C iI-s.o0,
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COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDectlon .odtionl
~d.d.. r-.>t.w 'br5u.JtJ~e.-+ f'\,..l6 C,eN~rPl*,R. I ~(!..-+
~e""'I1~A ON l~" CO>Jcr~-L PAA) Cu-\- />-,.:;1 ?,.,..~
A $~t\' l.j..- b, IL \,., ~ .1.v.ll~ br-i e> F- ~L-( M, R. co-NJ t.l <, +-
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
,--.,.
S:P!:!!rm1tsIForrnsIEtectr1ca1 Appllcatlon ApI' 2006