HomeMy WebLinkAbout07030072 Application
("~~;F::~ ,'< Cit.,v of Carmel/ Clay Township ;1t 07 D J 00 7 J-, ;
\ " / APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
FAX
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CONTRACTOR
INFORMATION:
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Street Address
City
State
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CONTACT PHONE:
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NAME
APPLICANT
INFORMATION:
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Property Owner /
(or agent) .
OR
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Contractor ~,_/"'- -;G7T,!te-
Representative
TYPE of WORK:
.. RESIDENTIAL:,
..... ,>.' COMMERCIAL:
PROPERlY OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:
5~c_
STREET AODRESS:
City
State
,
Zlp
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?TR~ET AODRESS (INSPECIlO~ LOi:ATlONlnJr
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City
State
Zlp
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TIME OF INSPECTION:
v. ~
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
o NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of METERS:
j
x
,
I CERTIFY THAT THE INFORMATION CONTAI~ED
ON THIS FORM IS COMPLI: II: ~CCURA.TE.
'-~~~~
Signature .
C,t:-bt';I C. ~/:rr 3-(J-,77
PRINT DATE
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 CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
,,>ntJ(>r'/ L/P.6/...~r d/.....,,~$ ~;('" A".,....... L_"...,."" -::Z;V'YJ"',.';-."c/
'5e(;. J!7t!;-.#,Tff .:76//00</6.-
;
FEES:
nSi $ 55.50 for Residential Inspections
plication Apr 2006