HomeMy WebLinkAbout07050164 Application
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( " ~,lQ;o 1 City of Carmel! Clay Township~.i-~'/ I
\" ,,;. / APPLICATION FOR ELECTRICAL INSPECTION
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PHONE (:J17),?/S:fs.14 FAX
CONTRACTOR
INFORMATION: Street Address City
';!:J.2 t) t:t7tff'dRAT.r~/I PI{ lAlLY pL.s.
State Zip'
/lIPf4N4 ~~ 5'tf,
APPLICANT
INFORMATION:
NAME
MARLAfJD w.i RrrA A. ;Y}Y€R5
CONTACT PHONE:
(317) t?'4b -CJ84-:3
Property Owner
(or agent)
vi
OR
Contractor
Representative
TYPE of WORK:
RESIDENTIAL: V
COMMERCIAL:
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
MIiR.LANO 1'01. (' RrrA A.l1y&?.s
PHONE:
(:3/7) #4(.-t:JB43
STREET ADDRESS: City
//44:.5 t/I?Cf/IlIfO ?AiRK) .$.p~. /)/lJ/'1J1/4i"od1S
State ZIp
mv (4)>.4 41"z8o
STREET ADDRESS (INSPECTlON LOCATION):
City
State
Zip
INSPECTION
INFORMATION:
U TIME OF INSPECTION:
. MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
o NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of METERS:
lli NEW MffiR SERVICE (i.e, Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility servic~or an area) ?/ikW .57:/lIJ(JB
/lQor/J~ .52, 6J1i1!fO'J'/y1'I L:i".iAl.eRATtR.
o ROW SIGNAL, SENSOR, MONITOR (i.e, Tralfft{ignt5 "
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
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NARLAND J1/.}!Yc"'F(5 4!..AY /tf7CJo1
PRINT DArt
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
FEES: $ 104.00 for Commercial Inspectio
or Residential Inspections
S:Permlt5/FormsjElectrlcal Application Apr 2007