HomeMy WebLinkAbout14060110 Application 4`�.�oF cnR _ Permit # ��060//Q
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City of Carmel/Clay Township
` " "' �-µ APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE &S�/_ Q��O FAX
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CONTRACTOR r �'I�(Il.dn.STC�C /GrU Mil4 c �c� C3i >> ��� -orao
INFORMATION: Streetnddress Ciry State zip
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NAME CONTACTPHONE:
APPLICANT C l f <i�� l S� 7 �e T � / � � '�od�
INFORMATION: properry Owner Contrador
(or agent) OR Representative �_
TYPE,ofWORK: RESIDENTIAL: � �� � OMMERCIAL•
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PROPERTY OWNER NAME(S): HONE:
PROPERTY JUN 17 2014
OWIVER
INFORMATION: �E�^ooRess: ciry state Zip
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: .STREET PDDRESS(MSPECfION LOCATION): City Sta[e� Zip
INSPECTION � y��a ( �� v. Cc,Q�c �iU �/(�d � �/
INPORMATION:
DATE OF INSPECTION: TIME OF INSPEC7ION:
TYPE OF IMPROVENiEIVT:
Number of NEW CIRCUITS:
O UPGRADE SERVICE From to Number of METERS:
O UPGRADE PANEL BOAf2D(S) .
� ADDIIION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING FLECTRICAL DISTRIBUION'SYSTEM
O NEW METER SERVICE (i.e. Fountain in pond; I CERTIFYTH T THE INFORMATION CONTAINED
' Subdivision;street or signage lighting; Installation of ON T � D ACCURATE.
' `�:"` new utility seryices for an area) ' —
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O ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light) s :_��?�
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O GONNECfION or RECONNECTION TO A RELOCATED
STRUCTURE P��T o"TE
COMMENTS or FURTHER LOCATION GLARIFIGATION: (Please atEach map of inspection location)
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FEES: $ 119.00 for Commercial Inspections; $ 65.50 for Residential Inspections
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