HomeMy WebLinkAbout07070013 Application
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Ctty ofCarmelA61ay Townshtp [Ngec-""TlON
APPLICATION FOR ELECTRICAL INSPECTION
:J:-
CONTRACTOR
INFORMATION:
v.
PHONE FAX
I I'" c.. 31=l- -"?OZ -1'~S-~ - '1=1-- T<-~ b>l/S"
Oty State Zip
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CONTAcr PHONE:
NAME
15
NAME
APPLICANT
INFORMATION: Property Owner
(or agent)
OR
"3'r -7-52-- (t.>
Contractor V
Representative ~
TYPE of WORK:
RESIDENTIAL:
COMMERaAL: )(
PROPERTY OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:
~,
STREET ADDRESS:
Oty
State
I
Zip ,
30 ~o 2.e:<>SEllct..-=T olE. /,..,DIPItV IN
STREET ADDRESS (INSPECTION LOCATION): Oty State
INSPECTION 1-0 G.Hl-A.v-.J"f) bl!.- C 0vt€L (J
INFORMATION:
~(,Z1t:J
Zip
TIME OF INSPECTION:
.'-' .' $",~
TYPE OFIMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
~ NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
Number of METERS: .1-
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) ,
SIgnature
-AJMI'/
PRINT
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
LO<..(t,Eb @ SO(..LT~ v-JEr;., c..oR-Ncr'L of 'S'f(E:(...B,OIAR-NE'Jlj~ NUb
A-~Ntf 1-/-16-lfLAND \)0'2.. N-8<-T To L:>o..tL"-E lJ..'TIL-/TfJ::oLt::..I:LHM.\ q/p'3D
FEES: $104.00 for Commercial Inspections; $ 57.50 for Residential Inspections