HomeMy WebLinkAbout07060105 Application
City of Carmel! Clay Township O~ tJ6 C;{ ()~
APPLICATION FOR ELECTRICAL INSPECTION
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FAX
NAME
PHONE
CONTRACTOR
INFORMATION:
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City
State
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APPLICANT
INFORMATION: Property Owner
(or agent)
CONTACT PHONE:
fb~;Z(,OS
OR
Contractor
Representative ~
TYPE of WORK:
RESIDENTIAL:
COMMERCIAL:
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PROPERTY
OWNER
INFORMATION:
PROPERlY OWNER Ap 4. J k,
PHONE:
5' 7 j-l(I't'/
7;;7ESS, !/b.:d 4- euJ Clw ;~
STREET ADDRESS (INSPEmoN LOCATION): Ciw State Zip
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DATE cg ~NS~~O : TIME OF INSPECTION:'
TYPER:1:1F MP OVEI':1ENT: J~f -I' ~MOVING SERVICE FROM OVERHEAD
- ~ -p~ ;# (A-. TO UNDERGROUND?
A-
D UPGRADE SERVICE: From to 0 YES 0 NO
D UPGRADE PANEL BOARD(S)
Zip
c;toZ"L
INSPECTION
INFORMATION:
Number of NEW CIRCUITS:
D ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRlBUION SYSTEM
Number of METERS:
D NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
I CERTIFY THAT THE INFORMATION CONTAINED
o FORM IS COMPL AND ACCURATE.
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D ROW SIGNAL, SENSOR, MONITOR (i,e, Traffic Light)
D CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
Signature
,
J}AV/O ASflr'.AUG /I ,1- /3-07
PRINT , DATE
FEES: $104',00 for Commercial Inspections; $ 57,50 for Residential Inspections
S:Permlts/Forrns/Electrical Application Apr 2007