HomeMy WebLinkAbout07060020 Application
City of Carmel/ Clay -Township -* 61 Db 66 ~O
APPLICATION FOR ELECTRICAL INSPECTION
I
NAME
PHONE
FAX
CONTRACTOR
INFORMATION:
City
-Pd "
I
State ZIp
~v~/A/'v_I4/6;Z:!>-
NAME
CONTACT PHONE:
APPLICANT
INFORMATION:
:5/7
,_
Contractor L,,_o/a- ?'<<:rr:~
Representative &~ -'17 S<./
....---
OR
TYPE of WORK:
_ ..- RESIDENTIA~:
--- - -~ -COMMERCIAl::: L.. ~r'--:-<<-
PROPERTY OWNER NAME(S):
PHONE:
CA1ib/~~
PROPERTY
OWNER
INFORMATION:
IS
STREET ADDRESS:
City
State
Zip
~71 t.-U. /O'tt ~f,ur
STREET ADDRESS (INSPECTION LOCATION):
t-?:.
::;2::.-..,p,Af/</4!-
INSPECTION
INFORMATION:
State Zip
(':.. /' HL-t' ? -;::Z/~ ,d/'va.-.
TIME OF IN~PECITON:
... /
MOVING SERVICE FROM OVERHEAD --
TO UNDERGROUND?
o UPGRADE SERVICE: From
- to
o -YES
o NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
I}c! NEW MffiR SERVICE (i.e. Fountain in pond;
Subdivision street or signagelight~ Installation of
new utility services for an area) po"'~ (;,)'.",,-rf-'
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
Number of METERS: I
- ,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMP~ ACCURATE.
~ftAL/4 ~
SIgnature
o CONNECITON or RECONNECITON TO A RELOCATED
STRUCTURE
lj.,t:br',-;r C. ,v,,//r
PRINT
~" ~--()7
DATE
COMMENTS ry}JRTHER LOCATION CLARIFICATION:
'Ii vNe.- b - -I
(Please attach maD of insDection lo~tiOn)
I
FEES: $
o for Commercial Inspec ons; $ 55.50 for Residential Inspections