HomeMy WebLinkAbout07070059 Application
City of Carmel/Clay Township 4I==-OlOl DOS'}
APPLICATION FOR ELECTRICAL INSPECTION
NAME
PHONE
CONTRACTOR
INFORMATION:
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FAX
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Street Address
City
State
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NAME '15 fZ!;:T 1:50 to "0
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CONTACT PHONE:
APPLICANT
INFORMATION: Property Owner
(or agent)
OR
Contractor
Representative
TYPE of WORK:
RESIDENTIAL:
COMMERCIAL:
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
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PHONE:
6<(9 -97'77
STREET ADDRESS:
Oty
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State Zip
foz4, ~
Iv <1LPcJ31.
STREET ADDRESS (INSPECflON LOCATION):
INSPECTION IZ- (2- b ~ ~1
INFORMATION:
DATE OF INSPECTION:
City
State
Zip
CA-/lf;Aif (
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TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
~DE SERVICE: From loD
o UPGRADE PANEL BOARD(S)
Zoo
to
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? ,
DYES ~'~
Number of NEW CIRCUITS: ~
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o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of METERS: (
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE,'
~~
o 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)
Signature
7;;/07
DATE
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
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PRINT
I
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:Permlts/Forms/Electrlcal Application Apr 2007
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