HomeMy WebLinkAbout07070063 Application
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City of Carmel! Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
CONTRACTOR
INFORMATION:
4:0 <.N; fLI'IIG
State
PHONE
FAX
)( 7-lI'1 (-039
City
ZIPI
GOO
CONTACT PHONE:
NAME
APPLICANT
INFORMATION: Property Owner
(or agent)
TYPE of WORK:
RESIDENTIAL:
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S)' , ^
OIl'''''A l-MO j)r5v'-.
$-:;<;;>'/
STREET ADDRESS:
30'ft A-!3rJEY POI.},
STREET ADDRESS (INSPEcnON LOCATION):
INSPECTION
INFORMATION:
DATE OF INSPECTION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
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)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
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OR
Contractor
Representative /'
1-//5 - ()'f~~ "(
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COMMERCIAL: ........---
PHONE: :IJ"lO flc.s; ..;pv
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State Zip
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City
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City
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Zip
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State
TIME OF INSPECTION: <t/..f{ '5--z...---
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
rrr-NO
Number of NEW CIRCUITS: -3
Number of METERS: . I
I
I CERTIFY THAT THE INFORMATION CONTAINED
I
ON THIS FORM IS COMPLETE AND ACCURATE!
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/c'eu.'...... S -L.Joy~ 7-/0-(:1/
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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. / iJ ~) (o{'f\.PA {I 4;arO?-- ~i-n-+ 'pr ~
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FEES: $104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:PermltsjForms/Electrlcal Application Apr 2007
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