HomeMy WebLinkAbout07030013 Application
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City of Carmel/ Clay Township !
APPLICATION FOR ELECTRICAL INSPECTION
tJ~ () 30 (J /3
CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
NAME
~ j\J E let- +r-,,,- I.--/..- c:...
Street Address
St/D {;., Polk. Ave. >v:~c:t:l:f/
NAME
;U. t4"..... HfI.,-I
Property Owner
(or agent)
RESIDENTIAL: X
PROPERlY OWNER NAME(S):
Ova", L4r-l-tq~
STREET ADDRESS:
, I ~ ?17 I N'-1. wood.
2- ~ ~1J
INSPECTION " (
INFORMATION:
PHONE
FAX
.:?(?-8>S7-~IIr, 3i7-Z,BB-'10 9
City State Zip
0-Y(:( .., LVooJ
i..{IPjL-/s
-:I,tU
CONTACT PHONE:
S 17~ r;i38 -~ 13.0
OR
Contractor
Representative
x
COMMERCIAL:
PHONE:
317- '?3B -o'{o~
City
C:::~r~o!(
State Zip
...\ (\J Lffoo3 3>
City State
<1I'~C ( :r N
TIME OF INSPECTION:
Zip
4~633
f??3> 7 T(~l-t
DATE OF INSPECTIO . 3-;j -07
TYPE OF IMPROVEMENT:
!
o UPGRADE SERVICE: From i to
o UPGRADE PANEL BOARD(S) A' rJl~
~ON, ALTERATION, REMoDEt~r~AIR TO.
AN EXISTING ELECTRICAL DISTRIBUIO~~~YSTEM
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage iighting; Installation of
new utiiity services for an area)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
AVty
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
o NO
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
SlgZ!. rJrl C)~
;U4 + L, ~.... H n '? 1-(
PRINT
?, - (-07
DATE
COMMENTS or FURTHER LOCATION CLARIFICATION:
...H..1 J
(I.-(~ IF (AI"{.'{ A
G.-d{ I"L.",",C ~17- c;,~8-'J.(30
(Please attach maD of insDection location)
FEES: $ 100.00 for Commerciallnspectionsi $ 55.50 for Residential Inspections
S:Permlts{FormsjElectrical Application Apr 2006