HomeMy WebLinkAbout07010101 Application
City of Carmel! Clay TownshiJf'l~4 ~ .
l APPLICATION FOR ELECTRICAL INSPECTION
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FAX I
3(7-'6'7613~
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CONTRACTOR
INFORMATION:
NAME
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Street Address
<67tJ 1 ;?-/oYl S VI /I e
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NAME
APPLICANT
INFORMATION:
JOn Ric-hards
Property Owner
(or agent)
TYPE of WORK:
RESIDENTIAL:
PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
PHONE
3/7-'i!76-J73
City
State
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CONTACT PHONE:
OR
3 I 7- S' 76 - :.? 73
Contractor V
Representative ~
COMMERCIAL: X
PHONE:
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STREET ADDRESS: h City
'00 E Cf6-f st~ SI4(fe 100
STREET ADDRESS (INSPECTION LOCATION):
INSPECTION 1, s-t, 4-
INFORMATION:
State
I
Zip
.1
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City
,
Zip
I
I
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State
I/V
DATE OF INSPECTION:
TIME OF INSPECTION:
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
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Instaliation of
new utility services for an area)
~ ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
1
I
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? i
I
I
Number of NEW CIRCUITS: ( ;
DYES
)8J NO
Number of METERS: I
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
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T(>n R/dClrdS l/n/r57
PRINT . DATE I
.
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permits/Forms/Electrlcal.Appllcatlon Apr 2006