HomeMy WebLinkAbout07070066 Application
I
City of Carmel! Clay Township I
APPLICATION FOR ELECTRICAL INSPECTIO~
t ~ b OO~ '
FAX I
)( /- i5'1 (-039
NAME
CONTRACTOR
INFORMATION:
to 00 I It! 'l/e.
,
oty
State
,
Zl
PHONE
bOO
CONTACT PHONE:
RESIDENTIAL:
'PROPERlY OWNER NAME(S)' 115 - (') t-j :) ,
tv'OIA<V L/hVO DCVL; ;;t-:Z7,vw
STREET ADDRESS: City
APPLICANT W
INFORMATION: Property Owner
(or agent)
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
L-
STREET ADDRESS (INSPECTION LOCATION):
INSPECTION
INFORMATION:
7 /11 I '0 1
DATE OF INSPECTION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
0' NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
NTS or FURTHER LOCATION CLARIFICATION:
e. S-e.
1<(0
OR
Contractor
Representative ,/'
COMMERCIAL: ..........-
PHONE:
::JY"'O P <-J, j:n/
Lv'D Su in: (9 <.\
, '
(, ~/ 8'
State
,
Zip
I
'9"- ~ OPJSVI LLE:
City
,r/
State
Zip
TIME OF INSPECTI~N::::t-405S
MOVING SERVICE FROM OVERH,EAD
TO UNDERGROUND?
DYES
IB"" NO
Number of NEW CIRCUITS:
-3
i
,
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
~ !
,7 I
t6~,:,., Ie uJ,."., --c/ 7-/0--6;>
PRINT DATE :
(Please attach mao of insoection location)
I FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:PermltsjForms/Electrlcal Application Apr 2007
I,
5 t-fCLJf3~C
~O\ \1(.
, '<J V
']7 l{'rpr+/J_?kJJV ~
.5 i-\ I t'..L"-Y /.-/ VI. rV~ f) vA. /i.~ c-rJ G" $'1 b' b 7 II
e A VLL 5','~ %.,v{",-tll-d Jl-\ N 5;;LJ-L/ b b f3
Q)>
::<0;1
~Z
~m
~-<
m
CG)
€il
j>m
~z
~e
It
~
,
..~!
\S"
.~
/"IJ})( u:;:?-) / ) I
si-'- 4e~, I
I-jrc;;'Y I
lJ~OI
\---
.....
"
/'
JIG/::.
3~
I
I
.
i:
.
f
.
"
"
\
""\
D;,
V{
';\>
'"
~
("'
\'
"
~
r;,i,,'TC' '~~-
4Y b".r-
Mtf)<:'
f'"
r
-1l
).:11
7.4
/l'J1[''P
/
-z..
v