HomeMy WebLinkAbout07030214 Application
City of Carmel! Clay Township J D 1 0 302../ L}
APPLICATION FOR ELECTRICAL INSPECTION
NAME
CONTRACTOR
INFORMATION:
/5
APPUCANT
INFORMATION: Property Owner
(or agent)
TYPE of WORK: RESIDENTIAL:
PROPERlY OWNER NAME(S):
PROPERTY 'is,....
OWNER
INFORMATION: STREET RESS:
30 ~-:.
INSPECTION N"ZEf I J.A-
INFORMATION:
PHONE FAX
s-
Dty Stale Z;p
h IN
CONTACT PHONE:
.317- Sz.. -
Contractor .-L
OR Representative
COMMEROAL: V
PHONE:
31
DIy State Z;p
A", 4(/;21.
DIy Stale Z;p
r~ TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
rsl'NO
o YES
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
Number of NEW CIRCUITS:
Number of METERS: .!l-
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
" fY1"NEw METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
,
I CERTIFY THAT THE INFORMATION ONTAINED
ON THIS FORM IS COMPL A A RATE.'
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
)j~ ,v{r--h e-l
PRINT
3(!!.o / D1-
DATE
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE '.
COMMENTS or FURTHER LOCATION CLARIfICATION: (Please attach maD of insDection location)
?o~ 5:.t?PI-7 ~I"'q Fct2.- ERWrTffou.~~ ;.JCTIAbV21:S' ON ,-,::>, I {f z-
FDtL. c..A.J.~" F ..-: v .
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/Forms/Electrlcal Application Apr 2006