HomeMy WebLinkAbout07040189 Application
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CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
INSPECTION
INFORMATION:
City of Carmel! Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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PHONE FAX
'-AZE~ HO/i?ES ..317 6/..9- 3:53/ .311 flr'JOlt!
Street Address City
9dO,;( I--! MD(/D/Ad 5k 3110 J:;./P f5
NAME
State
I~
Zip
(t.;Jt, (;
NAME
If! M E,e~ IT r - 8EAU~ )/Off/E.5
Property Owner
(or agent)
CONTACT PHONE:
,3/1 5/..9 3:53
OR
Contractor
Representative
RESIDENTIAL:
COMMERCIAL:
PROPER1Y OWNER NAME(S):
f3EII L to R- J-! 0!l1E5
STREET ADDRESS:
9cJ 0:2 ;J MERiDIAN Sir 300
PHONE:
.3/7 5roc70353!
State
Zip
c./ h.2 /,0
City
.JNDf't.5
L/
STREET ADDRES.S (INSPECTION lOCATION): City
/ ~7<!Cf J~ FDR-5Y1l-1 57- C/f.
i/~~
State
Zip
t/ t, () 3.;:J
EL
Sri
TIME OF INSPECTION:
DATE OF INSPECTIO~
TYPE OF IMPROVEMENT:
u
NG SERVIC~ FROM OVERHEAD
o UNDERGROUND?
o UPGRADE SERVICE: From
to
o NO
DYES
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
o ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of METERS:
o 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 CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE;
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o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
Signature
--riA JVl ~f!.I2ITT
PRINT
ij.c25-()7
DATE
COMMENTS or _fURTHER LOCATION CLARIFICATION: (Please attach
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FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:Permlts/FOrTns/Electrlcal Application Apr 2007