HomeMy WebLinkAbout ApplicationPermit # 42011, 0TO9001Y
City of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
NAME
PHONE FAX
CONTRACTOR
S K l L AN C
(310 yS /- 3 y b
INFORMATION:
streetAdcress
city state zip
9041 Ititcrsrnl-r is(.AW.9 /Co
S e-zus€ N 13207
NAME
CONTACT PHONE:
Q R IOlstr (0;(
APPLICANT
INFORMATION:
Property Owner
Contractor
(or agent) OR
Representative ✓
TYPE of WORK:
RESIDENTIAL:
COMMERCIAL: ✓
PROPERTY OWNER NAME(S):
PHONE:
PROPERTY
C I 0- M UL
OWNER
INFORMATION:
STREET ADRESs:
ory sate zip
STREET ADDRESS (INSPECTION LOCATION):
City State Zia
INSPECTION
r r7r7 31f-d Avcr S-W
CAt'mtz OV
INFORMATION:
DATE OF INSPECTION: 9 J
TIME OF INSPECTION:
PM
B (_,ILF 3
TYPE OF IMPROVEMENT:
❑ UPGRADE SERVICE: From to
❑ UPGRADE PANEL BOARD(S)
❑ ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
C2/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)
❑ CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
❑ YES O NO
Number of NEW CIRCUITS:
Number of METERS: T
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
Signature
64 JD&C - - (oy 11/09
PRINT GATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach man of inspection location)
/V au 11n 6n'x- S fit. v i c E P 3K C TL R I C tot - w I e c'D rV n r r S U I ri k,
FEES: $ 111.00 for Commercial Inspections; $ 61.00 for Residential Inspections
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\Permits\FORMS.ADplications%Electrcal Inspedcri\2009 Electical Inspection Application.aoc