HomeMy WebLinkAbout07110064 ApplicationC'CWKd/tyFF\..
y City of Carmel/Clay Township 0'7/l0?
APPLICATION FOR ELECTRICAL INSPECTION
\ - IAN.A•;.
NAME PHONE FAX
CONTRACTOR N uti '.R t 6GTvZ1C 7f.5 • 6113 19176 765 • ruH3 - y52o
INFORMATION: street AddreSS city state Zi9
2161. Ot}Ia qvE. AN-Dk:t&5Cr-/ LAI '16016
NAME CONTACT PHONE:
APPLICANT 1 r
?01LP4 CAQVAFL W&TE?L
l l7
3- 4
. 5063
INFORMATION: Property Owner Contractor
(or agent) ?- x OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL: u
PROPERTY OWNER NAME(S): PHONE:
PROPERTY wKii- \j Wee- 3t7- -733 • 2955
OWNER
INFORMATION: srxEE Tj ADDRESS: atr scare zp
3'150 Q 131sT ST• WESTFt l?l 4(.07K
STREET ADDRESS (INSPECTION LOCATION): qty State Zip
INSPECTION 3145c t.), t3tsT _ IREct) Lh( 1401
INFORMATION:
DATE OF INSPECTIO .' I
' TIME OF INSPECTION
(
te
r
FY
TYPE OF IMPROVEMENT: - OVING SERVICE FROM OVERHEAD
_TEB TO UNDERGROUND?
lK UPGRADE SERVICE: From 200 to 8 ? YES CO NO
O UPGRADE PANEL BOARD(S)
® ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
O NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
C CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
Number of NEW CIRCUITS:
Number of METERS: L4
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
Signature
IttlAtJ
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
QWW:z-10'-'0L- V7i ftlfDpe FCO A l- 2.C04 SWVtC6 TG H - 2-00 6. 04err- 6 wIT4+
FEES: $ 504,60 for Co
0 for
Inspections
'A
S:PemiWFor 5/Electr;;irApplicadcn Apr