HomeMy WebLinkAbout07050227 Application
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( , .~ ~ \ City of Carmel! Clay Township 0705 [)22
\ . ~'/) APPLICA TION FOR ELECTRICAL INSPECTION
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NAME
PHONE
FAX
CONTRACTOR
INFORMATION:
fr
81(]- 22/2.
29g
w~->-f CarM.e-I Dr.
CarJ"-ld
/J
S1?7-/s- "3
ziPI
(. D32-
,
,
City
State
NAME
CONTACT PHONE:
APPLICANT
INFORMATION:
:IO~",
ff
.5:() 7- 8730 c&
Property Owner
(or agent)
x
OR
Contractor
Representative
TYPE of WORK:
RESIDENTIAL:
COMMERCIAL: X
PROPERTY OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:
R.~
8 -2Z( 2-
City State Zip
D Car 032
City State Zip
rJ\l 'b52..
INSPECTION
INFORMATION:
l1tx
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
/
5/3/-
TYPE OF IMPROVEMENT: ;(98 &r: '.
i6 013600000 3WOO
(5/l UPGRADE SERVICE: From / to Q to ZCOQ .
.
~ UPGRADE PANEL BOARD(S)
DYES
o NO
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of NEW CIRCUITS:
Number of METERS: I
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FO S COMPL :A.ND ACCURATE.
ef
,
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Instailation of
new utility services for an area)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
Signature
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
~~pj~ol;'j JC.;<is';';':j ~ /to A-/, >.erV/CJL fl..o:r Wef" cJa;.,,',,.._ L-oJi.,..... I-
he..., 200 ~r c::e.YIJi,.. tJJ i It.. G:.~ tN il-JL -
~/-, '" ). k i r/", ;Pr
PRINT /
S-> 30.07
DATE
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:Permlts/Forms/Electrlcal Application Apr 2007