HomeMy WebLinkAbout07020068 Application
City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME /', /"/ 6t:ecv/c:..-
CONTRACTOR Ge-/,,,.,,,r C. ",,-
INFORMATION: Street Address .
PHONE
FAX
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City
State lip
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NAME
CONTAcr PHONE:
APPLICANT G/~"f"yr
INFORMATION: Property Owner
(or agent)
C~rr
3/7-,n;.z--97~-~
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Contractor "-<';. ~".~e-
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Representative
TYPE of WORK:
RESIDENTIAL:
COMMERCIAL:
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PROPERTY OWNER N~ME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:
Sa
i,;l77 u/. /,5~
City
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State
Zip
,
STREET ADDRESS:
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STREET ADDRESS (INSPECTION LOCATION):
City
State
Zip
INSPECTION
INFORMATION:
7~;.l..
. ,,;n(' t-- ;;Z;~",/;..a....
TIME OF INSPECTION:
~
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
TYPE OF IMPROVE
o UPGRADE SERVICE: From
to
DYES
o NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
(i1N EXISTING ELECTRICAL DISTRIBUION SYSTEM
W METER SERVICE (i.e. Fountain in pond;
^ ubdivision street or signage lighting; Installation of
new utility services for an area) .
Number of METERS: I
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE A CURATE.
~ROW SIGNAL: SENSOR, MONITOR (i.e. Traffic Light)
CONNECTION or RECONNECTION TO A RELOCATED
.' STRUCTURE .
COMME TS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
, Signature
GL..6,Pr'T Co ~7T
PRINT
:2. - .g"c) ?
DATE
cation p
I
I
55.50 for Residential Inspections
I
100.00 for Commercial Inspection