HomeMy WebLinkAbout07070133 Application
CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
INSPECTION
INFORMATION:
City of Carmel! Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
o107013~
NAME
FAX
tU!4
PHONE
(j11) 717-3Ztf6
Oty State
,uV~ r~$d'<" :ci'\J
L. A, W b t:(f vtv.c.
Street Address
I OJ ~ ~ 2 tv ~.e.--k ~;.
Zip
L/bDbO
NAME
CONTACT PHONE:
'317-716-'8675'
Contractor ~.
OR Representative
COMMERCIAL: ~/
PHONE:
A .,
I
State Zip
00 :f'ilJ ; 1M< Cl
City State Zip
~~ ()?2
TIME OF INSPECTION:
L t>JvV
w~b
Property Owner
(or agent)
RESIDENTIAL:
PROPERTY OWNER NAME{S):
Y IV -<-
DATE OF INSPECTION:
to
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
~O
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
DYES
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICALDISTRIBUION SYSTEM
~NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
Number of NEW CIRCUITS: I
Number of METERS: I
I CERTIFY 1: AT THE INFORMATION CONTAINED
ON THIS M IS COMPLETE AND ACCURATE.
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
UA/l-oV\A It W./LIo 7/;q /17/
PRINT ( , D~TE .
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDectionlocation)
:s"-trvA- /i5 l-i. ) VY\ccr c:J~V..{' r-. ~-4 -# d
I
I
,
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
I
S:Permits/FormsfEiectrical Application Apr 2007
.
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