HomeMy WebLinkAbout07100047 Application.-,\Or CqR?
City of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
NAME PHCNE FA.K
CONTRACTOR le9,7-r 317 75-e/ i7 ?Ug - "5-
INFORMATION: Street Address city sate zp
NAME CONTACT PHONE:
APPLICANT r? 17 6'"-o7S
INFORMATION: property Owner Contractor
(or agent) OR Representative
Pif:v,,c
TYPE of WORK: RESIDENTIAL: COMMERCIAL: 06. K/j
PROPERTY OWNER NAME(S): PHONE:
PROPERTY
OWNER
INFORMATION: STREET ADDRESS cry state zip
o? 7 7 Idea ?Tr r r f ,f
-??A?Ki. JG Ci3 rv?.?.?GL
STREET ADDRESS (INSPECTION LOCATION): City State DG
INSPECTION
INF ?Ae Cp eL raL?
ORMATION:
DATE OF INSPECTION: TIME OF INSPECTION:
a 1,9 J i, lr -e
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
? UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
O 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)
O ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
O CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
O YES O NO
Number of NEW CIRCUITS:
Number of METERS: I
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
Signature
to/,, r C. ?.7T /o/r?r 7
PRINT ?-
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
a *' So - 1:.2s- 4fn r ? 2 Z 61 ;P;/- /c el ;?- l Ph7 ai ez! Yl
FEES: t#W for Commercial Inspections; $ 53.50 for Residential Inspections
S:PermiL/Forms/Electrical Aoplkation Oc 2003