HomeMy WebLinkAbout07070096 Application
t0707COQ(P
City of Carmel! Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
NAME
FAX
CONTRACTOR ;n/e cS Fie cf,./ca
INFORMATION: Street Address
S";l.<t 15rookside Ln
NAME
APPLICANT
INFORMATION:
erS
o er
Property Owner
(or agent)
TYPE of WORK:
~
RESIDENTIAL:
PROPERTY OWNERNAME(S):
PROPERTY
OWNER
INFORMATION:
11" GIQW Cle
- STREET ADDRESS:
/::228 VOMh\
SlREET ADDRESS (INSPECnclN LOCATION):
INSPECTION / ~ ;;2.
INFORMATION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
'Is<(" ADDmON, ALTERATION, REMODEL, or REPAIR TO
r AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
o NEW METf;R SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; lristailation of
new utility services for an area)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
Move W1elf'r
000
PHONE
City
State
Zip
'1-0/68
f~/,jJ
X/Y
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CONTAc:r'PHONEa C . 1 , \
IIUJr~ =" -~ J > -
coWa'dtbr JUL 1 2 2007
t II I \ I. ~......-
Representative (./
u u
-111 \iI
I~
I
OR
CO MER.CIAL:
PHONE: (3/7) 8'1-8-;)-. 7G 7
City
Car_e/
Oty
State
Zip
..IN
If (, O.J.2...
State
Zip
CarYl""! JA(
TIME OF INSPECTION:
lfb63
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? I
DYES
(8J: NO
Number of NEW CIRCUITS:
Number of METERS: (
I CERTIFY THAT THE INFORMATION CONTAINED
O~ORM IS ~PL~E AND ACCURATE.
~(WL4~
Signature
Rorer V M;'I...r...5 7/;.3/0 '7
PRINT DATE
(Please attach maD of insDection location)
S:PermJtsjForms/Electrical Application Apr 2007
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
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