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CITY OF CARMEL
PERMIT RECEIPT
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OPERATOR: vdolan
COpy # 1
See: Twp: Rng: Sub: Blk: Lot:
PARCEL ID .... ....: ELECTRICAL
DATE ISSUED.......: 05/16/2007
RECEIPT #.........: 25097
REFERENCE ID # ...: 07050138
SITE ADDRESS...... 11708 FORREST DRIVE
SUBDIVISION ......:
CITY .............: CARMEL
IMPACT AREA ... ...:
OWNER ............: BRIGHTHOUSE NETWORK
ADDRESS ..........: 3030 ROOSEVELT AVENUE
CITY/STATE/ZIP ...: INDIANAPOLIS, IN 46218
RECEIVED FROM ....:
CONTRACTOR .......:
COMPANy...... ....:
ADDRESS ..........:
CITY/STATE/ZIP ...:
TELEPHONE........ .
TELECOM PLACEMENT
LIC # ETELEPLA
TELECOM PLACEMENT, INC
15405 LITTLE EAGLE CREEK AVE
ZIONSVILLE, IN 46077
(317) 752-7758
ICIIELEMTR FLAT RATE
TOTAL PERMIT :
METHOD OF PAYMENT
1. 00
104.00
0.00
104.00
NEW:BAL
~~~~]~~~~
0.00
FEE ID UNIT
QUANTITY
AMOUNT
PD-TO-DT
THIS REC
AMOUNT
104.00
NUMBER
0.00
104.00
CASH
TOTAL RECEIPT :
104.00
------------
------------
104.00
CITY OF CARMEL / CLAY TOWNSHIP
IMPROVEMENT LOCATION PERMIT APPLICATION
For ELECTRICAL INSPECTION
Permit #: 07050138
Date: 05/16/2007
PARCEL 10 #: ELECTRICAL
LOT & SUBDIVISION:
ADDRESS OF CONSTRUCTION:
Township?: Zoning:
11708 FORREST DRIVE CARMEL, IN
Flood Zone: Lot Split:
PROPERTY OWNER INFORMATION:
Name: BRIGHTHOUSE NETWORK
Ph. #: 3177527758 Fax #: 3177694645
Street Address: 3030 ROOSEVELT AVENUE INDIANAPOLIS, IN 46218
CONTRACTOR INFORMATION:
Name: TELECOM PLACEMENT, INC
Ph. #: (317) 752-7758 Fax #: (317) 769-4645 Email:
Street Address: 15405 LITTLE EAGLE CREEK AVE ZIONSVILLE, IN 46077
APPLICANT INFORMATION:
First Name: ADAM Last Name: MYETICH
Ph. #: Fax #:
Street Address:
PERMIT TYPE: MELECTRIC ELECTRICAL PERMIT/INSPECTION
Residential or Commercial:
Service Upgrade: Current Amperage:
Panel Board Upgrade: New Meter Service:
Number of New Circuits: Number of New Meters:
Relocated Structure Connection: Moving Service (Overhead to Underground):
Alteration, Addition, Remodel, or Repair to Existing Distribution System:
Upgrade Amperage:
Row Signal:
Special Notes/Conditions:
ELECTRCIAL INSPECTION FOR CABLE BOX, 11708
FORREST DRIVE, ACROSS STREET FRO DUKE POWER TRANS
FORMER #9C3, BETWEER 11708 AND 11626 FORREST DR,
ADAM - 752-1094 . NO NOTES'
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This permit is valid only if construction commences within one (I) year of the date of issuance of the State Commercial Design Reldase.
All construction must be completed (C/O issued) within two (2) years of the issuance date. I
J, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a structure, or any change in the use of
land or structures requested by this application will comply \vith, and conform to, all applicable laws of the State of Indiana, anel the "Zonibg
Ordinance of Carmel Indiana -1993" (Z-289) and amendments, adopted under authority of l.c. 36-7 et seq, General Assembly of the State bf
Indiana, and all Acts amendatory thereto. I further certify that only kitchen, bath, and Door drains are connected to the sanitary sewer. 1 I
further certify that the construction will not be used or occupied until a Certificate of OCClJp:lflCY has been issued by the Departmerit of
Community Services, Carmel, Indiana. I
APPLICANT NAME: ADAM
FEES:
ell ELECTRICAL/METERB.
MYETICH
104.00