HomeMy WebLinkAbout06090123 Application
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M".J..",/ MOVING SERVICE FROM OVERHEAD "
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o UPGRADE PANEL BOARD(S) -- \ lacolt1 110~
VI Number of NEW CIRCUITS:
o ADDmON, ALTERATION, REMODEL, or REPAIR TU /
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM Number of METERS: -I--
ts/J NEW METER SERVICE (Le. Fountain in pond; I CERTIFY THAT THE INFORMATION CONTAINED
(\ Subdivision street or slgnage lighting; Installation of FOR PLETE AND ACCURATE.
new utility services for an area)
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CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
TYPE of WORK:
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PROPERTY
OWNER
INFORMATION:
INSPECTION
INFORMATION:
City of Carmel/Clay 'Township :df:- 0 ~!Jet 0 / ~3
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE V I\( .I/)\{ I
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FAX
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,Street Address
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State
Zip
City
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Property Owner
(or agent)
Contractor
Representative
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COMMERCIAl:,
PHONE: Iii V - 'i I Y I
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PROPERTY OWNER NAME(S):
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STREET ADDRESS:
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state
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110
STREET ADDRESS (INSPECTION LOCATION):
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State .
5').5
11\\ '2-l?V
TIME OF INSPECTION: '1- /0.'36
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DATE OF INSPECTION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
o ROW SIGNAL, SENSOR, MONITOR (i.e, Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
FEES: $ 100.00 for Commercial Inspections;
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iallnspections
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5: Permits/Forms/Electrical Application Apr 2006