HomeMy WebLinkAbout07060086 Receipts/Permits
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Ctty of Carmel/ Clay Townshtp I
APPLICATION FOR ELECTRICAL INSPECTION
CONTRACTOR
INFORMATION:
NAME
l:::vl<-C 0vGfZ&'/
Street Address
NAME
APPLICANT
INFORMATION: Property Owner
(or agent)
i/
V
TYPE of WORK:
RESIDENTIAL:
PROPERTY OWNER NAME(S):
PHONE
FAX
City
State
Zip
CONTAcr PHONE:
~
17 24-s-crCf I (
OR
Contractor
Representative
COMMERCIAL:
PHONE: i
I
3/7- 8t.f3-'i'1' II I
I
City State ZiP:
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City State Zip
CPtR.MO- 1# %x>82-.
TIME OF INSPECTION:
(Y1d,,....)
PROPERTY
OWNER
INFORMATION:
srREET ADDRESS:
(DID CL.-u.~c C,
INSPECTION
INFORMATION:
srREET ADORESS (INSPECTION LOCATION): (p
183 ?AJCYIE:v..JDIZ :t=f,
. DATE OF INSPECTION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
~ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
o NEW METER SERVICE (Le. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utiiity services for an area)
o ROW SIGNAL, SENSOR, MONITOR (Le. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
~NO
Number of NEW CIRCUITS:
Number of METERS:
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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f0r t33 'P,~E-\JI2uJ fJp"'t. %., 1-DIN&-.
S:Permlts/FormsfElectrlcal Application Apr 2007
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections