HomeMy WebLinkAbout07050276 Application
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City of Carmel/Clay Township.:-- . .
APPLICATION FOR ELECTRICAL INSPECTION
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FAX I
:3';I..?-- 3~3}
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CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
INSPECTION
INFORM~TION:
NAME
~c',> ~l~C+RJC""L SP~\.h(C'r'"
s;e~~r2 ~: ~ ~
NAME
0AN'e ~ \?:J-ArJ!CJJ<.-'
Property Owner
(or agent)
RESIDENTIAL: c..----
PROPERTY OWNER NAME(S):
I)N /e 7;,e1<;
STREET ADDRESS:
416 t& rO'3.r,d?
STREET ADDRESS (INSPEcrJON LOCATION):
L\:AD ~cvVt IO?~P
DATE OF INSPECl10
TYPE OF IMPROVEMENT:
dUPGRADESERVICE: From leo
o UPGRADE PANEL BOARD(S)
to. ~ C90
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
o NEW METER"SERVICE (Le. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
o ROW SIGNAL, SENSOR, MONITOR (Le. Traffic Light)
o CONNECl10N or RECONNECl10N TO A RELOCATED
STRUCTURE
PHONE
317-3J.:J.-'59'f'f
City
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State
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Zip
7"C.Ab3rYI"'"
CONTACT PHONE:
"'3 ;).). -s 9 4"" <f"
OR
Contractor
Representative
COMMEROAL:
PHONE: 57/- S>Lf'l
'f/~- 7772?
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Zip
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City
~
State
City
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,
Zip
State
Of
TIME OF INSPECl10N:
MOVING SERVICE FROM OV
TO UNDERGROUND?
DYES
~O
Number of NEW CIRCUITS: I-J (I ^
Number of METERS: 0;1..-.0 I
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
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JAm",,, BLAJ.1..... 5"-::'( ~ q?
PRINT DATE I
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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FEES: $ 104.00 for Commerciallnspectionsi
sidentiallnspections
S:Permlts{FormS/Electrlcal Application Apr 2007