HomeMy WebLinkAbout07050049 Application
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City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
CONTRACTOR
INFORMATION: Street Address
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NAME
APPLICANT
INFORMATION: Property Owner
(or agent)
TYPE of WORK:
RESIDENTIAL:
PHONE
FAX
City
State
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CONTACT PHONE:
OR
Contractor \. /'
Representative~
COMMEROAL: X I
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PROPERTY
OWNER
INFORMATION:
PROPERTY OW~ER NAME~ --rr
G, Q.At>(.;E;- H-
U--(J7io V 0 (/iZ-4bdHONE:
STREET ADDRESS: ') II .-0: 0" 0
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STREET ADDRESS (INSPECITON LOCATION:
INSPECTION r
INFORMATION:
TYPE OF IMPROVEMENT:
JZI UPGRADE SERVICE: From /Oil to ;1 "()()
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 CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLAR~FICATION:
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TIME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
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TO UNDERGROUND? I
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DYES
~NO
Zip
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Number of NEW CIRCUITS:
Number of METERS: L
I CERTIFY THAT THE INFORMATION CONTAIt:-lED
O~.HI RM IS COMPLETE AND ACCURATE.
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SIgnature
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PRINT DATE I
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(Please attach maD of insDection location)
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FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Resid~ntial Inspections
S:Permlts/FormsjElectrlcal Application Apr 2007
Survey Boundaries
- Township Lines
Transportation
Abc Interstate Hwy Text
Abc U.S. HwyText
Abc State HwyText
=::0 Interstate Highways
= U.S. Highways
-. State Highways
::B:::Il Primary Roads
-- Minor Roads
0 Buildings
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Map1
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SCALE 1 : 3,296
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FEET
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http://www.co.hamilton.in.us/maps/cou nty. mwf
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Monday, May 07,2007 1 :50 PM