HomeMy WebLinkAbout07050138 Application
....GityofCarmelIClay'!~hip .' .
APPLICATION FOR ELECTRICAL INSPECTION
'061 ?
NAME
FAx-
PHONE
CONTRACTOR. ~ .~c~
INFORMATION:' SlnietAddress
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31~ ':-=rs:z'~?-?-~
Oty
. ~I:r .~<:t,'.'.' ti.#5'
'State Zip-:
, APPUCANT
. INFORMATION: ;PfbpertyOwner
(or agent)
I t-.I .q fRO. '1-
NAME
OR
'3{ r - "TS2."" Ii.>;
Contractor
Representative X
COMMERCIAL: X.
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TYPE of WORK:
RESIDENTIAL:
PROPERTY OWNER NAME(S):
PHONE:
PROPERTY
OWN,ER "C
INFORMATION:
BIU
SE ^,Er
3'
-Co%2-
'c..:ro 2e>r::>SE:.Ve<-T II€.
stliEET ADDREss (INSPECTION LOCATION):
Oty
!iJDtiWA
Oty
State
ZIp ,
,
;.~{,41f!:J
IN
State
ZIp
INSPEctION
. INFORMATION:
.I/"To 0
. DATE OF INSPECITON:
TO
TIME OF INSPECITON:
- - ~ -- - .
TYPE;OF'IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE'SERVICE: From
to
o YES
~""NO'
o UPGRADEPANEL'BOARD(S)
o ADDITION, AlTERATION,REMODEL, or REPAIR TO
ANEXISllNG ELECTRIcAL DISTRIBUION SYSTEM
,--.",'V':.-c
Number ofNEVVCIR.CUITS:'
Number of METERS: .1-
)t;".
. ." -
NEV\I,Mt:1tR SE~VICE (i.e. Fountain in pond;
. Subdivision str:~tbrsignage lighting; Installation of
new;utilityserilfcesfor an area) .
I CERTIFY THAT THE INFORMA
ON THIS FORM IS COMPLETE
S~4 /61-
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
DcCOi'JIiJECrrONorRECONNECITON TOA RELOCATED
srRUCTtJRE
SIgnature . \
~:ij~'feh<-l
" '-'.~
. . ,
COM MENTSor FURTHER LOCATION CLARIFICATION: (Please attach mal) oflnsiJectiorii6cation)
rJ iO.vJ "-A.1!:L..E Tv ?o~Q. SU.P?t-Y eA~rNer "a5Twee".) UTt)~ ANt:::> .;
/ICoz.u ~R/2e~-r"b.e.. Ac.aoss ,ITIE o;;T~= .- Reo,,^-
PlA.f<..c"POWetL -ri2.A.rv...~4f Cjc...3
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. FEES: $104~OOfor€ommercial Inspections; $57.50 for Residential<Inspecti.ons
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