HomeMy WebLinkAbout07060049 Application
City of Carmel/ Clay Township ~~O 00Dlfl
APPLICATION FOR ELECTRICAL INSPECTION
NAME
PHONE
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Oty
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FAX
(3n~S'-IS-71'fI/
CONTRACTOR {f\\J tt.im{ ~('+'II'c...-
INFORMATION: Street Address
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State Zip
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APPLICANT
INFORMATION:
NAME A
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CONTACT PHONE:
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Property Owner
(or agent)
OR
Contractor
Representative X
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TYPE of WORK:
RESIDENTIAL:
COMMEROAL:
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
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PHONE:
7S'J.. -D/'(O
STREET ADDRESS:
City
State
Zip
STREET ADDRESS (INSPEcrJON LOCATION):
INSPECTION (b1C.\lV\\i. v.x:>od
INFORMATION:
City
State
Zip
TYPE OF IMPROVEMENT:
l\l\~ 01\
MOVING SERVI FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
o NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~ NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
Number of METERS: I
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
T THE INFORMATION CONTAINED
OMPLETE AND ACCURATE!
,
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
I
GRGI 1P-:>:} (, },/07
PRINT ' DATE I
(Please attach maD of insDection 10JtiOn)
I
1
COMMENTS or FURTHER LOCATION CLARIFICATION:
FEES:
ommercial Inspections; $ 57.50 for Residential Inspections
5: Permits/Forms/Electn
7