HomeMy WebLinkAbout06050122 Application
CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
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City of Carmel/Clay Township . 06 tJ 501 A.:2.
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE
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FPX
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Street Address
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NAME I
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City
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Zip
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State
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CONTACT PHONE:
Property Owner
(or agent)
Contractor
Representative
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OR
"--' COMMERCIAL:.
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TYPE of WORK:" -.. .. ....RESIDENTIAL:.- ".
PROPERTY
OWNER
INFORMATION:
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PROPERTY OWNER NAME(S):
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PHONE:
'$'\'"7 - 25'cr-ClJeS
State . ZiPI
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STREET ADDRESS:
City
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50<>'2- ~. 5~A-
State
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STREET ADDRESS (INSPEcrION LOCATION):
INSPECTION QQ'8 f ~"""""",,-.r L,A'l.L--
INFORMATION:
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E OF INSPECTION: I
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SERVICE FROM OVERHEAD
NDERGROUND?
TYPE OF IMPROVEMENT:
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o UPGRADE SERVICE: From to
DYES
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
~ ::::E:~ICT~i:LF:~:: in pond' ) TEM
.r ~~~division street or g Ing; nstallation of
new utility services for an area)
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'5- \7-06
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DATE I
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COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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Number of NEW CIRCUITS:
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Number of METERS:
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
.J~~...;
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
PRINT
Commercial Inspectionsi $ 55.50 for Residential Inspections
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