HomeMy WebLinkAbout07050191 Application
\.~~ ~.://
City of Carmel! Clay Township ,/tF / '/
APPLICATION FOR ELECTRICAL INSPECTION
I
NAME
CONTRACTOR
INFORMATION:
(1\\1 ~("fC\"" C~c:.\-< ie...
Street Address
L/&'30 ;'I\cLuJ\;;") ~rk.w
NAME
PHONE
(,317 ,/S"-)J5S"
oty
:rr.c/ pi)
FAX
9-IS-7/9'-/
State Zip
;rrJ %8)(0
CONTACT PHONE:
APPLICANT
INFORMATION:
\::'irt ~~t<.\l..- V'rI"O~o\UV1-t C,WlpCd\ po- Y3S8
Property Owner Contractor
(or agent) 'X OR Representative
TYPE of WORK:
RESIDENTIAL:
PROPERlY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
ic.'(..
fu",,^~ w I'1t
STREET ADDRESS:
S70;). 'Grit u'h\~~
STREET ADDRESS (INSPEmON LOCATION):
INSPECTION [IItr
INFORMATION:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
,J NEW METER SERVICE (Le. Fountain in pond;
I Subdivision street or signage lighting; Installation of
new utility services for an area)
o ROW SIGNAL, SENSOR, MONITOR (Le. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
c::;"o O,1\c.Ju..J t'h",r
COMMERCIAL: fJ
PHONE:
l>-lo.
GY'V\.
Oty
Jl1d b
(.311) 570 - <.j 35".9
>II
State Zip,
w
(j (p ;)..d-}
City
State
Zip
I
I
,
j ql.: dr.
TIME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
o NO
Number of NEW CIRCUITS:
Number of METERS:
,
I CERTIFY THAT THE INFORMATION CONTAIN~D
ON THIS FORM IS COMPLETE AND ACCURATE.
=3"o\-..", ~fG.c.. 54S'-)JSS lull 'i09-) 13&
Signature /
.s- ~3/o 7
PRINT DATE
(Please attach maD of insDection location)
FEES=($ 104.00 !or Commercial Inspections; $ 57.50 for Residential Inspections
S:permlts/Forms/Electrlcai7>.p'pucatlon Apr 2007 I