HomeMy WebLinkAbout07040023 Application
City of Carmel! Clay Township :?S::~I ~
APPLICATION FOR ELECTRICALINSPECTIONj
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Contractor ~
Representative
NAME
CONTRACTOR
INFORMATION:
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Street Address
NAME
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APPLICANT
INFORMATION:
Property Owner
(or agent)
TYPE of WORK:
./
RESIDENTIAL:
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
11m bore......-
STREET ADDRESS:
L/f5~ ~ 1'10061:.("('
PHONE
FAX
GC-
011- ?,;)~- L./837
City
State
(s
CONTACT PHONE:
OR
COMMEROAL:
PHONE:
City State . I
ZIP:
(Ij, t met .TN 4~O3
State Zip
INSPECTION
INFORMATION:
STREET ADDRESS (INSPECT10N LOCATION):
C_-7
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DATE OF INSPECTION:
/rJO
LA
,07
TYPE OF IMPROVEMENT:
~UPGRADE SERVICE: From dCD to lfDD
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
o NEW METER SERVICE (Le. 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:
TIME OF INSPECTION: )' D
I D f'^-
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
~
DYES
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS CCBLETE AND ACCURATE.! ,,\
~ !(Cel.)
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Sign re
j'(Lnrl.r~j)ol('"cJ- 1-( L if / 07
PRINT ATE '
(Please attach maD of insDection location)
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FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
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S:Pennlts/Forms/Electrical Application Apr 2007 I
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