HomeMy WebLinkAbout07060007 Application
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City of CarmelA@lay Township tv~
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR V- I IN c.. :31~ - S-~ - :51~ T<.-'i ",liS-
INFORMATION: aty State ZJp
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NAME CONTACT PHONE:
APPLICANT 73(~ -"?-5~-ft.>
INFORMATION: Property Owner Contractor -L
(or agent) OR Representative
TYPE of WORK:
RESIDENTIAL:
PROPERTY OWNER NAME(S):
PROPERlY
OWNER
INFORMATION:
B
STREET ADDRESS:
30;ro l2oeSE:IIEt-, olE
STREET ADDRESS (INSPEcnON LOCATION):
INSPECTION
INFORMATION:
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DATE OF INSPECTlON:
TYPE OF IMpROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
j;{
NEW METER SERVICE (i.e, Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an a rea) ,
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTlON or RECONNECTlON TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
New CABLE ~weQ 'S\A.?'PLy c:.A;ffSrME'T
Fbl:.E -4= 057- 14'((
COMMERCIAL: )(
PHONE:
31
Oty State ZJp
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TIME OF INSPECTlON:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
I}( NO
Number of NEW CIRCUITS:
Number of METERS: .1-
./
/1)")/
1 I t/
DATE
(Please attach maD of insDection location)
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FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections