HomeMy WebLinkAbout07030179 Application
City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
\X>.d1l.l~cl.c.f 3\a.ii'\07
aW.l"'<I. 1:l.'tlO
;
{
I
i
\ /
" /
"'INDI~~~ /
~--..;-,---- ; 1'J'/t?30 /'7 Y'
NAME PH0E FAX
(Y\\I I=,,~("<lf 8.eGTf h... (3\"/ SYS-11.:rS- L3rl) ::,-..,S "/7</
CONTRACTOR
INFORMATION: Street Address City State Zip
1-/ no IYlOwt<I<1 \ Y/'('5 :::r,J~b. TJ'..? '1bJJ<o
NAME CONTACT PHONE:
~D~i\ G....'tC\ 6''')s4r-''',>~- .r "O'1-/O~(, .
APPLICANT
INFORMATION: pr~~~D Contractor
(0 agent) OR Representative
TYPE of WORK: RESIDENTIAL: "* COMMERCIAL: ,
I
PROPERTY OWNER NAME(S): PHONE: I
PROPERTY \JOu.s s.. \ \ ; \JCl " ,10- 403 '1
OWNER
INFORMATION: STREET ADDRESS: City State Zip
q u,V\(olGl ct. CDrrne\ ~rJ 4W3,).,
STREET ADDRESS (INSPECTION LOCATION): City State Zip
INSPECTION q (O\~to cd S1-: c:o flVle \ :rN </603.2
INFORMATION: .
DATE OF INSPECTION: TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
JiS NO
o UPGRADE PANEL BOARD(S)
FjJ ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of NEW CIRCUITS:
56
I
Number of METERS:
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic light)
E AND ACCURATE.
'109-103(;,
oJ; NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
Slgnatur
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
PRINT
r..e~rt
'(. '\k..,,;s
31~Io/o7
DATE!
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
Nortln of IJfn-U sf. Yx.ml'tl!1'\ Y;e.j\1u~e ~ RQI"II}" \iN fcJ.
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts{Forms{Electrlcal Application Apr 2006