HomeMy WebLinkAbout07040003 Application
CONTRACTOR
INFORMATION:
City of Carmel! Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
?t G 00)
NAME
PHONE
FAX
E/eJ;el~
3'17-9.2.V-<;' 2.2-("
7d/- $/zy
Zip
<;at:> 2-" 2-
State
Oty
I/C/o I;
/"..}
,t) /L.'-I,A/ VI S
NAME
CONTACT PHONE:
9-h.
3/ - 9 2..-1 - ~-/ C; L.
APPUCANT
INFORMATION: Property Owner
(or agent)
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
Contractor
Representative ~
OR
. . RESIDENTIAL:
)0
.. " .-.- COMMERCIAL~- .....
PROPERlY OWNER NAME(S):
TOhN Ii Jt:
PHONE:
j77-.s~ 0 (:)
STREET ADDRESS:
Oty
CA{'(Y\~I
Oty
State
Zlp
jO{" 12- SprlN'/I'lI/l eJ
IAJ
-/(.,"32...
STREET ADDRESS (INSPECTION LOCATION):
State
Zip
INSPECTION D L S
INFORMATION: \0 I L r, IV
DATE OF INSPECTION:
I .;J '-/fj) 0 3. 2.-
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM 0
TO UNDERGROUND?
o UPGRADE SERVICE: From to
o YES ~ NO
Number of NEW CIRCUITS: ~
Number of METERS: I
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
r%' NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
~
&~:rc A L~~ ?
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
r9 DefLA::t1H
I
COMMENTS or FURTHER LOCATION C
RIFICATION: (Pie 5
otJl. r
~ z:; lr'(/~M1 (i!J!(t~
q;i;to
.
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/FormS/Elecb1cal Application Apr 2006