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HomeMy WebLinkAbout070402227 Application CONTRACTOR INFORMATION: APPLICANT INFORMATION: TYPE of WORK: PROPERTY OWNER INFORMATION: INSPECTION INFORMATION: NAME PHONE :j)oc / S ~Lf.C'tf.IC. 3d~ - 59l/t; Street Address City State 0133,;} '5.~~LiIl/61D,.J ...Lld>/l'/1VAtUUS ItV NAME CONTACT PHONE: DI'jv'ID -roMCuAK 3J'1) 'n3-/,?g7 OR Contractor Representative V / FAX Zip' . i Yb?03 I COMMERCIAL: PHONE: (311) j n::,- I ~ g1 RESIDENTIAL: PROPERTY OWNER NAME(S): SfO(;WICK /-L1Il.€DWNUS I1ssDclI'1norJ STREET ADDRESS: l>lIvlO IOMCifA;((/IIEM6El) City State 3lft.iif SEOGW ILK [.;wE W6<;rF,ff 0 rrl STREET ADDRESS fTNC:;Pi=r:nON LOCATION):[LPf I City State _ 'SB~;C.k-. _hi ., i3~~ 'Se~l.U:ck. L-r(. ~ vv&;,F,~D I.Jv DATE OF INSPECTION: TIME OF INSPECTION: , Zj~ , '-I6D7 Zip l/bo7Y I I , MOVING SERVICE FROM OVERHEAD TO UNDERGROUND? TYPE OF IMPROVEMENT: o UPGRADE SERVICE: From to f{NO Number of NEW CIRCUITS: DYES o UPGRADE PANEL BOARD(S) o ADDmON, ALTERATION, REMODEL, or REPAIR TO AN EXISTING ELECTRICAL DISTRIBUION SYSTEM ~ NEW METER SERVICE (i.e. Fountain in pond; [ ~ Subdivision street or signage lighting; Installation of new utility services for an area). Number of METERS: { I CERTIFY THAT THE INFORMATION CONTAINED O/1IS FORM IS COMPLETE AND ACCURATE. ~-(j;;J~Lv-- Srgnature' ~AVlh L lo';"CMK PRINT o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light) o CONNECTION or RECONNECTION TO A RELOCATED STRUCTURE l(47~7 DATE COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location) THe: BU.LtNG ,4J>olE"rS Ice TIt€ Et..€CiilC. Me-TEl viI 1)IIICC fNEU,'/ IS 3/<)& Dotlc<;,4(.. Gfl.CL€. W~TFIE-t..f). DI 'IbD7Y . FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections S:Permlts/FormsfElectrlcaJ Application Apr 2007 Jan 31 05 04:01p ~'" ,<> >'" zd ~ ~:EG1 "'-lr-mc ;;-2~Cl $ e ~~~ C;:;:oqJ5 OOZV>"I~ - ~ ~ ~2 "<> C\ei "'0 I ~~,,"::s;-t o ~ ~ ~~ ;- ~Dc::g:: ~~3~g3 <oltlltliii~ ; :.E.~~~ c:::TO ::1_ ri':i:2: ~:;!:~; :;a.a.'9..!l::r ~.o.2.ii1. u o.~ !.~~ ;:"!!,. .... g. ~~.g g ~ ~ <_30._0 ;-::Sl1ltl3"C:1 g,~a!:o O'~]- 5- g- a: ".::1_ III 1;; t,lI!l ~g qI (11 a~.:3 =I g O'n Q. III -a ~;;.gg 3- ~Q..l>>:rOlD ... o::SCQ:S ~ o3;;-g-i= 't:l' it Q Go .. !. ~ iil 3 Q~ S :r=3 -'O;r I: g g :t ~ ... :i"OIl;;IOI~ Ie n~:rg ~ ~~~c:~=- g.. CI"Q III :;. _. ~ :::iI C ::;! 0 ~!~;qs. . w" a.- (h ~g1o:;tt :t a. ii c:r:llQ (i'''3l\1~!. .... <l "," " .., . ~;,~.g:- _Ii' 0 _, ~ a0'3~ Q. o"'",,,,D. aoQ,;::IQ _~crc.:s ~!~a~ ~~ic:l8 c.n -8::1 lC:S<!. !. 5"" ~ e: ~~ ~ a;: ~ ~. ~~ g ::t=~ "< 00"_ ::ra.=-' "" z i'i Gl~1 -.....0.... .........-... ~~~5~ 'f'f"";;i ~e~:i!r- 8g{ij:S:::~ ~~~~~. O_az ~~~~ ~~~ ~rn ."l '" " ::; m l'l N Sedgwick ~ r---. --- '> t (" \f\ (' I) (<> .., J:-- 'I.", '- \I' ~ [. V . ' 0- ~ 1:7 r- ~ 7<- ~ t \":> - ~\ ~ l" > J:!> '-l '^ - 317-733-9609 p.l -:0 ..;~ ..~i!; ,.~. , :-~t ';;'> ;",;0 ,..,.., CfJ )-i.., >- n trrj ~ r" b ,....... >- ,. r" ~ 0 ',," --3 . ';'" --3 CJ > 0 ;." 0 0 0 . ')1 Z -C ~ ~ ~ N ( , n "0 >~ Z :.., 0 CJ) . ?ii e :r: 1--1 " " > " 0 Z ,....... fJ . ;-3 ""d '" ~ .;- ?\ .". ~ -.., " ;-~; ~. . ;; ~ <0 LtI ...;~ :~~ '" "'4.", --<to .... ~~ li ,.j :-~t ;~i; '" :< >{fJ · ~, ~ Q ~ ,~ ): ~ '" 0 ',f '. :',~ $:: ~.( ~ (n < \(.;. I s; .~ .~~~ ".'> .'/0 "~ l;;J .~f:e "~':> ~ .~o . 3i: , " 0 ~ 0. !. >. t\ z .<r. ~ ~ m ~ E on . ;