HomeMy WebLinkAbout07030043 Application
City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
'103 (}o'i.5
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NAME
CONTRACTOR
INFORMATION: Str.etAddr.ss
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NAME
APPLICANT
INFORMATION:
C-,t~u;r C. f?JF
Property Owner /
(or agent) V
TYPE of WORK:
RESIDENTIAL:
PROPERTY OWNER NAME(S): _
PROPERTY
OWNER
INFORMATION:
S'
STREET ADDRESS:
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STREET ADDRESS (INSPECTION LOCATION):
999j- d,,;,;!"':
DATE OF INSPECTION:
oJ -I -
TYPE OF IMPROVEMENT:
INSPECTION
INFORMATION:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
k ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
fl.jlue f'R);'....-",-r-
PHONE.
FAX
- (3/7 ,;'6;?-JC)(),5"
Oty
Zip
State
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CONTACT PHONE:
OR
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COMMERCIAL:
x
PHONE:
City
Zip
State
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State
Zip
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City
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TIME OF INSPE010N:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
o NO
Number of NEW CIRCUITS:
Number of METERS: j
Signature
C-,?.6#,,/ (' - ~; 7T
PRINT
3-7-07
- DATE
i
.
(Please attach maD ofinsDection location)
I
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FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspeq:ions
S:Permlts/Forms/Electrlcal Application Apr 2006
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