HomeMy WebLinkAbout07080133 Application
City of Carmel/Clay Township 4\ 0 1 () CO 0 ) ~ ~
APPLICATION FOR ELECTRICAL INSPECTION
NAME ,4(,,5 flecf-tJc PHONE FAX
CONTRACTOR 7b~1I S,/'I1PSOf1 Gn) LI"S-00b5'
INFORMATION: Street Ad~ress City State Zip
18/~ ASslet..<vqJ Ow ~r J:, J pfs 1>> 9'6228
NAME SLT CONTACT PHONE: C<=.>( "730-0'12</
!/.ifJ
APPLICANT 8iS--'7lh7
INFORMATION: Property Owner Contractor
(or agent) >< OR Representative
.
TYPE of WORK: RESIDENTIAL: x' COMMERCIAL:
PROPERTY OWNER NAME(S): S~-r PHONE:
PROPERTY t. /oyd .e <f lYlaAf ,4"., []10--'7lb9
OWNER ,.
INFORMATION: STREIT ADDRESS: City State Zip
4/3 Co"Co~/ Ie. , (ft1<.l!1 'i.v r {LJ 3:?
STREIT ADDRESS (INSPEC110N LOCATION): , City State Zip
INSPECTION Lit; COn. c---^ (! /) r~' I TIv LfGD~2..
INFORMATION:
DATE OF INSPECTION: tl- / lP"" 07 TIME OF INSPECTION: 1;2 - .2..,
I
\21 UPGRADE SERVICE: From !tJO to ZOO ~
~ UPGRADE PANEL BOARD(S)
,
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? I
,
,
TYPE OF IMPROVEMENT:
DYES
Ji'! NO
Number of NEW CIRCUITS:
o
o ADDmON, ALTERATION, REMODEL, or. REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of METERS:
('J
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
I CERTIFY THAT THE INFORMATION CONTAINED
ON T F: RMJS COMPLETE AND ACCURATE. I
/1-
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
Signature
t-Io'/J R Sfuo-r
PRINT'
8/f:)!o7
DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:PermitsjForms/Electrlcal Application Apr 2007