HomeMy WebLinkAbout06110067 Application
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/ ,"Rl~"'''F,/\1 City of Carmel! Clay Township ~~~
\ ' / APPLICATION FOR ELECTRICAL ~PECTION
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PHONE
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CONTRACTOR u ~ ILKVV~ ~ <T-
IN FORMA nON: Street Address City State Zip I
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NAME ~ b u 5 -r /:,.1 yY1 ~ y Ir \d JONTACTPHOZ <1 'i - '1 } ~ Iff
Contractor ~
Representative L/"'"
NAME
FAX
APPLICANT
INFORMATION:
Property Owner
(or agent)
OR
TYPE of WORK:
RESIDENTIAL:
COMMERCIAL:
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
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PHONE:
S<{'J. - lev/
STREET ADDRESS:
City
State
J3~
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",,-,
STREET ADDRESS (INSPECT10N LOCATION):
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City State
INSPECTION /3 "'1
INFORMATION: . C^,
DATE OF INSPECTION:
bo, At<.> cJ r ~c..r~(
TIME OF INSPECTION:
o UPGRADE SERVICE: From
to
,
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
~ 0 NO
Number of NEW CIRCUITS:
TYPE OF IMPROVEMENT:
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
~ EXISTING ELECTRICAL DISTRIBUION SYSTEM
I;i. NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
Number of METERS:
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
. ".,
n ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts(FormsjElectrical Application Apr 2006