HomeMy WebLinkAbout07040064 Application
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City of Carmel! Clay Township ,
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APPLICATION FOR ELECTRICAL INSPECTION
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FAX
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NAME
CONTRACTOR :::\Q..Q.-~,,-J S
INFORMATION: Street Address
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NAME
APPLICANT '\~~ ~.t:\ "'-
INFORMATION: Property Owner
(or agent)
PHONE
City
Cot..c~~ .J
State
Zip
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CONTACT PHONE:
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Contractor
OR Representative X--
TYPE of WORK:
RESIDENTIAL: X
COMMERCIAL:
PROPERTY OWNER NAME(S):
PROPERTY !~~
OWNER
INFORMATION:
PHONE:
City
State
lip
100Dc?D -r",v:>,,-,,- ~l c..~\N'.j 3"r-J l!(pIS32.
STREET ADDRESS (INSPEmON LOCATION): City State ZIP\
INSPECTION \')c. ~C> lov:>,,<:.../.Q-,t ~",'-A-(L~\ /'?~~
INFORMATION:
DATEOFINSPECTI07- M <-I W ') TIME OF INSPECTION: \Z--Z-!)
TYPE OF IMPROVEMENT: ~ -rltt /....----/ MOVING SERVICE FROM.OVERHEAD
I - TO UNDERGROUND?
r:iJ UPGRADE SERVICE: From boo to ;:'c -- 0 YES p. NO
~ UPGRADE PANEL BOARD(S) .
~DDrnON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~EW 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)
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Number of NEW CIRCUITS: <'CJ:
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,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.'
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Number of METERS:
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
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Signature
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PRINT '
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DATE I
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(Please attach maD of insDection location)
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COMMENTS or FURTHER LOCATION CLARIFICATION:
FEES: $104.00 for Commercial Inspection; $ 57.50 for R idential Inspections
S:Permlts/FormsJElectrlcal Application Apr 2007
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