HomeMy WebLinkAbout07050156 Receipts/Permits
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City of Carmel! Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR PiAL (lJ",e k900bf I ~crR...l<: 3S1-&7N)
INFORMATION: Street Address City State Zip
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NAME CONTACT PHONE:
APPLICANT
INFORMATION:
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Property Owner
(or agent)
OR
09c.)- ?93
Contractor ~
Representative I ..
TYPE of WORK:
RESIDENTIAL: .. '('
PROPERTY OWNER NAME(S):
~ frf'-lL Bu ~t<-lS
COMMERCIAL:
PHONE:
PROPERTY
OWNER
INFORMATION:
gL(tf- 071 L
! /; ~.-d; Sf /H.J(; 5
0rf!.-(J1 [L-
State
~
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I
Zip
c!003
lip
STREET ADDRESS: City
INSPECTION t
INFORMATION:
STREET ADDRESS (INSPEmON LOCATION):
City
State
~ft..LY>1 ~ L r V-
TIME OF INSPECTION: -2
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DATE OF INSPECTION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From to
~ UP~RADE PANEL BOARD(S)- ~ ~
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
fN 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)
DYES
o NO
Number of NEW CIRCUITS:
Number of METERS: /
I CERTIFY THAT THE INFORMATION CONTAI~ED
ON THIS FORM COMPLETE AND ACCURATE.
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o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
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PRINT
S)7/o "/
. DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspec~ions
S:PermltsjFormsjElectrlcal.Appllcatlon Apr 2007