HomeMy WebLinkAbout07060003 Application
CONTRACTOR
INFORMATION: '
APPLICANT
IN FORMATION:
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
INSPECTION
INFORMATION:
City of Carmel/ Clay Township
APPLICA TION FOR ELECTRICAL INSPECTION
o '/06000:3 t
NAME
,TeC:~V\o Elec\-r;L TV\c
Street Address
\DI)~~ E./,+,S+- Sl1eet--
PHONE
FAX
,
(:~\'1) 1'1lf -<1 '1 c..3
(3n )~1~r 11'+)
City
State
Zip
No\'\<>sv;\le
~N
%OCoQ
NAME
co ACT PHONE:
Co.+h Sf ~c.b
C3\1 ') '713-1:rD
Contractor
Representative X
I
I
I
I
Property Owner
(or agent)
OR
.
RESIDENTIAL:
COMMERCIAL: X
PHONE:
,
Zip
Y."J32
ZI1
I
,
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? I
o NO NA
STREET AODRESS:
City
(a( Me!
State
TN
STREET ADDRESS (INSPECITON LOCATION):
Oty,
State
(/v
DATE OF INSPECTION:
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From to
DYES
o UPGRADE PANEL BOARD(S)
-
Number of NEW CIRCUITS:
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of METERS:
'~ NEW METER SERVICE (Le. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE
I
~A..~ c7
C.a.H't .s. S~c.k:
PRINT
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
ro!l 101
DATE
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
c.es' 75' across '-\-i.e. 5-h-ed- Om the. b~(.k. of- f"-e
b u',\o.\ \A dose .+0 Q new h lack. -tell/ce. Call aroYl
at- 10- ,~ w(.t.h e.s +;0Y'\ leas),
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:Permlts{Forms/Electrica! Application Apr 2007