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City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
"J!LO ~~I\- () 1'/00 ';)0/
NAME PHONE FAX
CONTRACTOR ft3tlet ~?"rf/A;m au of [,J()fItN~ 3n {P'bIIcJ>.JLJ
INFORMATION: Street Address City State lip
(9!>()'77 FJ71 "'7r- /t-t i/ I Pr,,J'I/ &LI? ;A-! I
NAME CONTACT PHONE:
APPLICANT ~W",~ WelWfMc--...r
INFORMATION: Property Owner Contractor V- I
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL: /
PROPERTY OWNER NAME(S): PHONE: I
PROPERTY ~7U. Vt ~ ,-f WPI &-,.. '1 I
OWNER ( City ,
INFORMATION: STREET ADDRESS: State Zip
MeeT1,J~ P-O (1/t;IU-,,,,,, u>0; {!A..,(Mc-L.- I
!'1-7i)"j lA-I- ~L...>f'-
,
STREET ADDRESS (INSPEmON LOCATION): City State lip
INSPECTION [l7 t?1 MaT7A.1b/f~ .io ~ (,,-V . I
INFORMATION: I
DATE OF INSPECTION: TIME OF INSPECTION:
o UPGRADE SERVICE: From
to
,
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? I
o YES ~O I
TYPE OF IMPROVEMENT:
o UPGRADE PANEL BOARD(S)
. Number of NEW CIRCUITS:
o ADDmON, ALTERATION; REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of METERS:
t
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURAT~
. .6 'dl - /ttv'P' I ~;>
,
J2f NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Instailation of
new utility services for an area)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insoection location)
--rite Metet ~ ( 1"\7<f8- ~ lvCkI7?1> 4t IRW MA.'?o-J""( N/.lru.. /,./ j?~f:>~
,</? JC{ 7:'> ~ ec~-ZC1 ~1W<-fl4tL-
71<'1 '7~~/'-
PRINT
"7(..v(J'1
DATE
S:Permtts/FormsjElectrlcal Application Apr 2007
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
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