HomeMy WebLinkAbout07050252 Application
City of Carmel! Clay Township 1Pb7c5od-oZ-
APPLICATION FOR ELECTRICAL INSPECTION
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PHONE FAX
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State lip
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CONTACT PHONE: ..3'37-'- " 7~1
Contractor V-
OR Representative
COMMERCIAL:
PHONE: C:;<G -;l<7J.:<
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City State Zip
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City State Zip
NAME
CONTRACTOR L--
IN FORMATION: Street Address
APPLICANT
INFORMATION:
TYPE of WORK:
RESIDENTIAL: ~
PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
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STREET ADDRESS (INSPEmON LOCATION):
INSPECTION LM ~5 'Po.-JL p..Q
INFORMATION:
DATE OF INSPECTION:
TIME OF INSPECTION:
o UPGRADE SERVICE: From
to
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to6Q \ \ 01\
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MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
TYPE OF IMPROVEMENT:
DYES,
o NO
o UPGRADE PANEL BOARD(S)
~DmON, ALTERATION, REMODEL, or REPAIR TO
. AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of NEW CIRCUITS:
I
Number of METERS: '
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street orsignage lighting; Installation of
new utility services for an area)
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
3J9-0 751-'
o ROW SIGNAL, SEN,s.o_R,}fl0NITOR'(i:e.TrafficStught)
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o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
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Signature '
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PRINT '
DATE
COMMENTS or FURTHER LOCATION CLARIFI
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(Please attach maD of insDection location)
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FEES: $ 104.00 for Commercial Inspections;,$ 57.50 fi r Residential Inspe~ions
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S:Permlts/FormsjElectrlcal Application Apr 2007 '. I
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