HomeMy WebLinkAbout06060127 Application
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City of Carmel/Clay Township 'I tpt\J //,O
APPLICATION FOR ELECTRICAL INSPECTI01!'J .
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CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
INSPECTION
INFORMATION:
- '.- -'RESIDENTIA~:" -- - . COMMEROAL:
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STREET ADDRESS: Oty State
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STREET ADDRESS (INSPEmoN LOCATION): City Slate
133 00 ~\J~ &t'--te J>y.'v'l 13e..5+-u-....VV'J-X,v
DATE OF INSPECITON: b '20/ ()6 TIME OF INSPECITON:
NAME
Street Address
(OJ ~ ?>;2. C.V <' u\::. pj),
NAME
VJ.Jo~
LQ-vv
Property Owner
(or agent)
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~ MffiR 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 CONNECITON or RECONNECITON TO A RELOCATED
STRUCTURE
PHONE
FAX
'-317-7/b~b7~
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State
Zip
::r: AJ
46060
CONTACT PHONE:
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OR
Contractor
Representative
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Zip
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Zip
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MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
o NO
Number of NEW CIRCUITS:
Number of METERS: {
,
AT THE INFORMATION CONTAINED
RM IS COMPLffi AN CURATE.
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PRINT
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COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection loJtiOn)
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FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
.
S:Permlts/Forms/Elecbical Application Apr 2006