HomeMy WebLinkAbout07040075 Application
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( "~"'T~FJ(,,,F,o~ \\ City of Carmell Clay Township -4 07 D If (;() 1 r; .
\f(F" ...,.) APPLICATION FOR ELECTRICAL INSPECTION.
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NAME PHONE FI\X
CONTRACTOR NVZ"+ ~ 52.- 3{ ~'1- s-
INFORMATION: aty Slate Zip
16 IAI
APl'UCANT /10 .3/7- ~ sz. - S
INFORMATION: Property Owner Contractor ~
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: ~~~,r COMMERaAL: V
PROPERTY OWNER NAME(S): PHONE:
PROPERTY ~r- 31
OWNER
INFORMATION: STREET RESS: aty State Zip
30 ~"j:, 4672{.
STREET ADDRESS (INSPECTION LOCATION): Oty Stale Zip .
INSPECTION 10 O~ C~ L I,)
INFORMATION: , ~
- TIME OF INSPECTI PM
TYPE OF IMPROVEMENT: . . MOVING SERVICE FROM OVERHEAD
Ie:, 0 q 24-041) 4002.000 TO UNDERGROUND?
o UPGRADE SERVICE: From to /
DYES. ~NO
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
Number of NEW CIRCUITS:
Number of METERS: L
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE '."
SAJ
PRINT
DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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ad trig comi'j ().J-)" -fi,~,y){Oi'17 ;~
Sf 04.a) 111 :st)
FEES: $ 10(kt)(Hor CommerciallnspectionSi $ SS.SO for Residential Inspections
S:Permlts/FormsjElecbical Application Apr 2006