HomeMy WebLinkAbout07070064 Application
CONTRACTOR
INFORMATION:
City of Carmel! Clay Township I
APPLICATION FOR ELECTRICAL INSPECTI01j
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NAME
PHONE
FAX
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City ,
State Zip
1'10 I
CONTAcr PHONE: I
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Contractor
OR Representative /"
Street Address
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NAME
APPLICANT
INFORMATION: Property Owner
(or agent)
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
RESIDENTIAL: COMMERCIAL: ....----
PROPERTY OWNER NAME(S): t-f / ~ ~ Olf5 Ci PHONE: ~a? L.J;
INO' Arv" iD/L-. ga-.;;"""/..u l.A..i (l WlO r'^ \ ilZ ()
STREET AODRESS: Oty state
INSPECTION
INFORMATION:
A: @,fJcy t-+ { GN LA-N 0 I
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Zip
I
'f 00T77
DATE OF INSPECTION:
It I b1
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City State Zip
I
TIME OF INSPECTION: iI:- LJ-/ ~63
MOVING SERVICE FROM OVERH"EAD
TO UNDERGROUND?
ET ADDRESS (INSPECTlON LOCATION):
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
DYES
(B/ NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS: -5
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRlBUION SYSTEM
Number of METERS:
,
I CERTIFY THAT THE INFORMATION CONTAINED
,
ON THIS FORM IS COMPLETE AND ACCURATE.
~ I
o CONNECTION or RECONNECTION TO A RELOCATED f!ev I:" J - D-
STRUCTURE PRINT DATE I
COMMENTS or FURTHER L~~TION CLARIFICATION: (Please attach maD of insDection loc~tiOn)
CZrJ/-( y Wfk - )('f' /J'fr-P I
/ _'=3 fA) C~(,Y\M,- ~ !I ''oC!h/1/1 ~
Dr. .~ s ~orno, - ,'vt .q-~~__
(3' NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage Iig"hting; Installation of
new utility services for a n a rea)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
FEES: $ 104.00 for Commercial Inspections; $57.50 for Residential Inspections
S:Permlts/Forms/EJectrlca! Application Apr 2007
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