HomeMy WebLinkAbout06090001 Application
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City of Carmel! Clay Township 7 pi}? f)
APPLICATION FOR ELECTRICAL INSPECTION
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FAX
PHONE
NAME
317 7/0 -0 "q< ~
CONTRACTOR
INFORMATION:
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State
Street Address
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ZZONS vrt..L6' 'IN
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CONTACT PHONE:
NAME
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Contractor z/
Representative
COMMERGIA~:.... Jk,.
APPLICANT
INFORMATION:
OR
TYPE of WORK:
.- RESIDENTIAL: ..
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PHONE:
PROPERTY OWNER NAME(S):
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PROPERTY
OWNER
INFORMATION:
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City State
STREET ADDRESS:
L{730
;<06 W. OAfiA
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STREET AODRESS (INSPECITON LOCATION):
INSPECTION f;,
INFORMATION:
Zip
City
State
'I~Q :2,
MOVING SERVICE FROM OVERHEAD .
TO UNDERGROUND?
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
DYES
o NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS: Z
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o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~ NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
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Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
O~7S/M;e AN!:C~RA~.
Signature . 4-
Rrcl/lA r< '}, M. bit $'1 9 -1- 0 ro
PRINT DATE
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)'
M~nl? IS [oeAn)) &/lavr.. fl/0 A)o/!..,-J/ .~ WAd t',/;:: -rue
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FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections .
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5: PermIts/forms/Electrical Application ApT 2006