HomeMy WebLinkAbout07070065 Application
City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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APPLICANT
INFORMATION: Property Owner
(or agent)
W, rLI -.JG
NAME
CONTRACTOR
INFORMATION:
G CID
PROPERTY
OWNER
INFORMATION:
L.Ad() '/) r;:/k..
COMMERCIAL: ~
4/5 -' OI{~Df PHONE: 2JN()p,-~
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TYPE of WORK:
RESIDENTIAL:
PROPERlY OWNER NAME(S)'
STREET ADDRESS:
City
State
ZJp
37 gg A: rJCY?1. .t<'-
IT ADDRESS (INSPEmoN LOCATION):
I o.JSv, LLc /";'
City
<j (;, 077
State
Zip
INSPECTION
INFORMATION:
TIME OF INSPECTION:
~ 4-loSi
DATE OF INSPECTION: 1
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
{B'.. NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS: J
o ADDmON, ALTERATION, REMODEL,or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUlON SYSTEM
Number of METERS:
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
,
I CERTIFY THAT THEIN FORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
~~_ - I
~,' _/0-07
PRlNT DATE
0' NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for a n a rea)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FUR~ LOCATION CLARIFICATION:
(!J1>/;)- U/f//C - \-('t Y
(Please attach maD of insDection location)
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:Permlts/Forms{Electrlcal Application Apr 2007
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