HomeMy WebLinkAbout07010153 Application
City of Carmel/Clay Township {)17 tJ/tJ / 53
APPLICATION FOR ELECTRIC~~12lIQ
CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
TYPE of WORK:
/'
RESIDENTIAL:
PROPERTY
OWNER
INFORMATION:
99:>/
INSPECTION
INFORMATION:
STREET ADDRESS (INSPEcnON lOCATION):
( Plett ~t vJ ^
DATE OF INSPECITON:
TYPE OF IMPROVEMENT:
c1UPGRADE SERVICE: From )00 A to ZLJO A
rsI' UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELEcrRlCAL DISTRIBUION SYSTEM
o NEW METER 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 CONNECITON or RECONNECITON TO A RELOCATED
STRUcrURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
tjg-d>. + ?hA-~AN+ I./,tW
(
PHONE
FAX
317-717- <3J75"'
7..)--263-033.:<..
City
State Zip
'PeIJk,lJ
OR
Contractor
Representative
COMMERCIAL:
PHONE:
gJ€r If 1. 'I
City
Zip
State
State
Zip
TIME OF INSPECITON:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
~NO
DYES
Number of NEW CIRCUITS:
Number of METERS: i
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS CO PLETE AND ACCURATE.
/-Zt.(-o 7
DATE
(Please attach maD of insDection location)
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:PermltsjForms/Electrical Application Apr 2006