HomeMy WebLinkAbout07040021 Application
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City of Carmel! Clay Township /tA ~ rD:;f ;'f'
APPLICATION FOR ELECTRICAL INSPECTION
0'/0500 J.---
NAME
CONTRACTOR
INFORMATION:
LIVe. L0ln:.
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City State
Zipi
Street Address
APPLICANT
INFORMATION:
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NAM~ CUlcLr(L rv ou cd-
Property Owner
(or agent)
TYPE of WORK:
v'
RESIDENTIAL:
PROPERTY
OWNER
INFORMATION:
PROPERlY OWNER NAME(S):
~\ OLoI
CcrDf\
STREET ADDRESS:
INSPECTION
INFORMATION:
5 Apr bl
TYPE OF IMPROVEMENT:
~UPGRADE SERVICE: From -:-j.OD to.JlQ2
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)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNEcnON or RECONNEcnON TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
PHONE
FAX
~
Iv1d IS'
CONTACT PHONE:
OR
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Contractor
Representative
COMMEROAL:
PHONE:
City
State
liPl
Lj L,J2. m
_ W.
City
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MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? PrL-i"I-y(' {/(7
o YES ~NO. I
Number of NEW CIRCUITS:
Number of METERS: I
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE. (cell]
~o.n(L~ c0C}6te cJ- 7'0 - qc9-o 7
Signature :
...sO__nr:f(CLrpotLo + L! /4 ) 07
PRINT DATE
(Please attach maD of insDection location)
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FEES:
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$ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
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S:Permlts/Forms/Electrlcal Application Apr 2007