HomeMy WebLinkAbout06120044 Application
City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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CONTRACTOR
INFORMATION:
NAME JD /I 7<J cl-)OJO-S
&CfMe-5 tI, j)rew
Street Address
APPLICANT
INFORMATION:
~7()1 ~'-onsv[J(e R.d,
NAME
\It; n R /{., /'4 r-Js
Property Owner
(or agent)
TYPE of WORK:
RESIDENTIAL:
PROPERIT OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
PHONE
FAX
317-&76- 373c;
3/7-'676- 3'OJ..:r
Clty
Ind,4M 0/;5
State
Zip
:rN
'-I{'J...t~
CONTACT PHONE:
3/7-87C-373
Contractor
OR Representative X'
COMMERCIAL: ><
PHONE:
City
State
Zip
INSPECTION
INFORMATION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o 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 CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
City
State
Zip I
I
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
~ NO
Number of NEW CIRCUITS: I !;
Number of METERS: -L
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE. [
5~~:kn~
;:]Of" R;chqrdc, 1'd./r?'/06
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
_ROUI'lr/4bo'l+ q+ l../+hAve, Sw 4- !AI. f'.1tpIVlsf. on .C,NJ,+hIA/P-C:+ I
C--{)f 1'1 ~r
FEES: $ 100,00 for Commercial Inspections; $ 55.50 for Residential Inspections
5; Permits/FormS/Electrical ApplicatIon Apr 2006