HomeMy WebLinkAbout04120022 Application
DEC-02-2004 THU 03:54 PM
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FAX NO, ''-If4. /;?:p P. 02
City of Carmel/Clay Township /0 - /?- .(}O
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
CONTRACTOR .~ tl~'c
INFORMATION: Street Address
lcr~'-l kJ. ..LLU 1>.1 ~ I..:,. ST.
NAME
APPUCANT R\J~'::l . ~nW41 tJ
INFORMATION: Property OWner
(or agent)
TYPE of WORK:
RESIDENTIAL:
. PROPERTY
OWNER
INFORMATION:
PROPeRTY OWNER NAM,,!S):
IrC" R~L y CR-~\l
. STRSET ADDRESS (lNSPECTJON LOCATION):
1,-/ S-9 'f 4\N~ \!JA-y
STREEr ADDResS (INSPECTJON LOCATION):
INSPECTION
INFORMATION:
DATE OF INSPECITON;
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE; From
to
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~ NEW MffiR SERVICE (I.e. Fountain in pond;
Subdivision street or slgnage lighting; Installation of
. new utility services for an area) ~(J ""'/ La y-
O ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECITON or RECONNECTION TO A RELOCATED
STRUCTURE
PHONE
FAX
Sil- 'fl.";. (,1.2-1.
CIty
317 - "IZ?:'- b~ "3 <{,
Sla<e ZIp
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4 t ~z.
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CONTACT PHONE:
317 - CjZ,i - ~l/ L
OR
Contractor
Representative
L
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COMMERCIAL;
PliONE:
317- '5'77 .. 'S'1,1) t:)
Oty stab! Zip
~,eN\ tL IIV. 'if, 033.
Oty stab! .Zlp
TIME OF INSPECITON;
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
o NO
Number of NEW CIRCUITS: I 2-
Number of METERS: I
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND AcaJRATE.
72~VY\~~
Signature
(<\l~ M ~SI~A-/.j _
P1<INT
,z.L f... / 0'1
Tel
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of Inspection location)
S:PonnlES/FotmS/E1ear1ca1 Applbtlon OCt 200J
FEES: $ 93.50 for Commercia/Inspections; $ 52.00 for Residential Inspections