HomeMy WebLinkAbout06120033 Application
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City of Carmel/ Clay Township dF- 06/ 2. 0 033
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
FAX
CONTRACTOR
INFORMATION:
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~7- IJ '3
City
State Zip
2'1$1 Werf &1'
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60:57..
NAME
CONTACT PHONE:
APPLICANT
INFORMATION:
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OR
Contractor
Representative
. TYPE of WORK:--
.,_., "'RESIDENTIAL:'-- --.... .
'COMMERGIAl:- )<..
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
5"'1 if (;Je>+ Ca "md
PHONE:
STREET ADDRESS:
City
317- ~'IJ -2.1.(2-
State zid
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Z'I3 We.
Ca r/)1~
INSPECTION
INFORMATION:
STREET ADDRESS (INSPEmON LOCATION):
State
Z'R
{,o32-
TYPE OF IMPROVEMENT:
OVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
'Y
o UPGRADE SERVICE: From
to
DYES
~ NO
Number of METERS:
'fi
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o UPGRADE PANEL BOARD(S)
r$ ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of NEW CIRCUITS:
o NEW 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 CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
JOhv.. S. /(,'r-hv 1JL. /O-Zf-O'
PRINT I' DATE
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COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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: $ 100.00 for Commerciallnspecti nSi $ 55.50 for Residential Inspections