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CITY OF CARMEL / CLAY TOWNSHIP
IMPROVEMENT LOCATION PERMIT APPLICATION
For: ELECTRICALlNSPECTION
Permit #: 06080076
Date: 08/11/2006
PARCEL.ID #: ELECTRICAL
LOT & SUBDIVISION:
ADDRESS OF CONSTRUCTION:
Township?: Zoning:
BTWN 5691 & 5703 BLACKFOOT CARMEL, IN 46033
Flood Zone: Lot Split:
PROPERTY OWNER INFORMATION:
Name: REVEL-UNDERWOOD PROPERTY MGMT
Ph. #: Fax #:
Street Address: 7050 116TH ST E FISHERS, IN 46038
CONTRACTOR INFORMATION:
Name: PW. GOLLMER ELECRIC INC.
Ph. #: (317) 577-8487 Fax #: Email:
Street Address: 10418 HAGUE RD FISHERS, IN 46038
APPLICANT INFORMATION:
First Name: JOHN
Ph. #: 317-577-8487
Street Address: 10418 HAGUE RD
Last Name: GOLLMER
Fax #: 317-577-7871
FISHERS 46038
46038
PERMIT TYPE: MELECTRIC ; ELECTRICAL PERMIT/INSPECTION
Residential or Commercial: COM
Service Upgrade: N
Panel Board Upgrade:
Current Amperage:
.New Meter Service: Y
Upgrade Amperage:
Row Signal: N
Number of New Circuits: Number of New Meters: 1
Relocated Structure Connection: N Moving Service (Overhead to Underground): N
Alteration, Addition, Remodel, or Repair to Existing Distribution System: N
Special Notes/Conditions:
METER AD DR. MAY BE 5699, BUT METER IS BETWEEN 5691
AND 5703 BLACKFOOT TRAIL IN DELAWARE TRACE. METER
IS @TRANSFORMER SITE ON PROPERTY LINE. 100 AMP
SERVICE FOR IRRIGATION WELL. WILL CALL FOR INS. . NO NOTES'
This permit is valid only if construction commences within one (1) year of the date of issuance of the State Commercial Design Rel~e.
All construction must be completed (C/O issued) within two (2) years of the issuance date.
1, the undersign.ed, agree that any construction, reconstruction, enlargement, relocation, or alteration of a structure, or any change in the use of
land or structures requested by this application will comply with, and conform to, all applicable laws of the State of Indiana, and the "Zoning
Ordinance of Carmel Indiana -1993" (Z~289) and amendments, adopted under authority of LC. 36~7 et seq, General Assembly of the State of
Indiana, and all Acts amendatory thereto. I further certify that only kitchen, bath, and floor drains are connected to the sanitary sewer. I
further certify that the construction will not be used or occupied until a Certificate of Occupancy has been issued by the Department of
Community Services, Carmel, Indiana.
APPLICANT NAME: JOHN
FEES:
CII ELECTRICAL/METERS.
GOLLMER
100.00
Item
1 of
CITY OF CARMEL
1 PERMIT RECEIPT
OPERATOR:
COPY #
ier~
See: Twp: Rng: Sub: Blk: Lot:
PARCEL ID ........: ELECTRICAL
DATE ISSUED.......: 08/11/2006
RECEIPT #.........: 22907
REFERENCE ID # ...: 06080076
SITE ADDRESS ...... BTWN 5691 & 5703 BLACKFOOT
SUBDIVISION..... .:
CITY .............: CARMEL
IMPACT AREA ......:
OWNER... .........: REVEL-UNDERWOOD PROPERTY MGMT
ADDRESS ..........: 7050 116TH ST E
CITY/STATE/ZIP ...: FISHERS, IN 46038
RECEIVED FROM....:
CONTRACTOR .......:
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP ...:
TELEPHONE... ......
PW GOLLMER ELECTRIC
LIC # PWGOLLM
P.W. GOLLMER ELECRIC INC.
10418 HAGUE RD
FISHERS, IN 46038
(317) 577-8487
FEE ID UNIT QUANTITY
ICIIELEMTR FLAT RATE
TOTAL PERMIT :
METHOD OF PAYMENT
1. 00
AMOUNT PD-TO-DT THIS REC NEW 'BAL
---------- ---------- ---------- ----------
100 .00 O. 00 100.00 0 .00
---------- ---------- ---------- ----------
100.00 0.00 100. 00 0.00
AMOUNT
NUMBER
CHECK
TOTAL RECEIPT :
100.00
006272
------------
------------
100.00