HomeMy WebLinkAbout07050204 Application
City of Carmel! Clay Township
APPLICATION FOR ELECTRICAL INSPECTION,'
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NAME
PHONE
CONTRACTOR ~ ?flUc,,\\
INFORMATION: Street Address
FAX
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TN
City State Zip
LJ.\oGl
IJJES
NAME
CONTACT PHONE:
APPLICANT lS'(2Tf\N A-sl-fPAUG\-\
INFORMATION: Property Owner
(or agent)
'3 I - <1tD- 2I.DOS
OR
Contractor
Representative )(
TYPE of WORK:
RESIDENTIAL: X
COMMERCIAL:
PROPERTY OWNER NAME(S):
PHONE:
'31l- 4l.JlO - ':> 210'2.
DYES ;@- NO
Number of NEW CIRCUITS: ~
Number of METERS:
PROPERTY
OWNER
INFORMATION:
SPgr:N~ UW.6S 5STl'\rE'
HOA
STREET ADDRESS:
City
State
401 NAuAfl.D c.r. CA-l2..N6L 'DJ
STREET ADDRESS (INSPECTION LOCATION): .~ 'ft-f Y 1- City CP.\2.'"\EiL State
INSPECTION Ne:M. 3~Lf PINT"'"'" cr. lS.Ul!J)NI~" 6~~:1 U. '"IN
INFORMATION:
DATE OF INSPECTION: TIME OF INSPECTIO~
TYPE OF IMPROVEMENT: MOVING SERVICE FROM
TO UNDERGROUND?
o UPGRADE SERVICE: From to
o UPGRADE PANEL BOARD(S)
~ ADDmON, ALTERATION, .REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
I.
.'
Zip
,
't-\P'032.
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
Signature
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
Zo."h~ 80u.,1d6'n
PRINT
5l~LJ/ 0 7
ATE ,
COMMENTS or FURTHER LOCATIOr-l CLARIFICATION: (Please attach maD of insDection location)
QE'SE:T Me.k.r tsO,S,< Asse.mb\j
S?f\(\~ \..A~-t.s ~MmoJ\ - .spri n~rnil \
FEES: $104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:Permlts/Forms/Electrical Application Apr 2007