HomeMy WebLinkAbout06110102 Application
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CIty of Carmel! Clay Townshl
i APPLICATION FOR ELECTRICAL INSPECTION
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CONTRACTOR
INFORMATION:
NAME
LI'vt., WI 1"(.. ~1e.ctrIG LLC-
Street Address
\ d-.S 34 t.:, Go 51Jv Sj-
NAME
APPLICANT
INFORMATION:
Le-W\"; Ie (9.(
Property Owner
(or agent) OUJ n-e.r
TYPE of WORK:
RESIDENTIAL: ><.
PROPERTY OWNER NAME(S):
OR
PHONE
~
FAX
S2..("-423
CIty A State
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Lv') I~ V IrJ
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CONTACT PHONE:
lip
33Y3>L.f.,7; w 34'6-0{)9-f
Contractor
Representative
COMMERCIAL:
PROPERTY
OWNER
INFORMATION:
I 1 r;<V L-w,<:.-
E5tnles
Lewis \(. Gv;
i- SMcUra L. I; if
PHONE:
'1>48-0051-/1+ 337-3('('<{
5/3 -fosSl. c.
STREET ADDRESS:
3l7D Bvi
. S CoJr.-vtl e)
City
State Zip
INSPECTION 3110 ~r; cl <K 1k s.. 0-MVI1eJ.
INFORMATION:
DATE OF INSPECfIO ~
TYPE OF IMPROVEMENT: S7/-,z"f'f1
STREET ADDRESS (INSPE
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
){ 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 CONNECfION or RECONNECfION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
~nYJi:..J df'cf-n'cnj 'W ouf hu,'tdii:J
City
State Zip
/fJ 4(,035
IrJ
4-100]3
TIME OF INSPECfION:
M VING SERVICE FROM OVERHEAD
o UNDERGROUND?
DYES
o NO
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
s,gnatu;;dM1riAtJ. X4p;JJ0
-SA /'J 1>(2..4 L. S,P[ ~ 11/20/ bf..-
PRINT
DATE
(Please attach maD of insDection location)
-
FEES: $ 100.00 for Commercial Inspectio i $ 55.50 for Resid tial Inspections
S:Permits/Forms/Electrical Application Apr 2006
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