HomeMy WebLinkAbout07100028 Application`?? or fqy?:,
City of Carmel /Clay Township
w:r APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FA.X
CONTRACTOR GGrci.:c /7) _ 7.a-,075'1'
INFORMATION: Street Address city State Zip
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NAME CONTACT PHONE:
APPLICANT /oe--•- P. ", g/7 91-71y-y
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL: v
PROPERTY OWNER NAME(S): PHONE:
PROPERTY
OWNER
INFORMATION: STREET ADDRESS city state Zip
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STREET ADDRESS (INSPECTION LOCATION): CITY State Zi7
INSPECTION
INFORMATIO w'
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DATE OF INSPECTION: C TIME OF INSPECTION:
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TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
D UPGRADE SERVICE: From to
D UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
? ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Y EW 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)
? CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
O YES 4--y-26f O
Number of NEW CIRCUITS:
ITS:
Number of METERS: i
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
Signature
FRI. DATE'
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
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FEES: $ or Commercial Inspections; $j;YZ0-for Residential Inspections
S:Pernits/Forms/Electrical Application Oct 2003