HomeMy WebLinkAbout07070138 Application
City of Carmel! Clay Township I
I
APPLICATION FOR ELECTRICAL INSPECTION
I
(!) 1 (j (] / 3):
I
,
NAME
CONTRACTOR
INFORMATION:
K.5flu
E cd,.:c
Street Address
If'1J 4 E ,J3,-c
PHONE
FAX
I
./7 - 5~.) -" 10D 3/ -56J- -1010/
City State Zip
1:-/11 I
q ,},J8
CONTACT PHONE: I
,
317-61 -07.:2/
Contractor :L-
OR Representative
COMMERCIAL:
PHONE:
Oty State Zip
:;:: :<Lfo
City State Zip
Cq/' e T;1I '16032.
TIME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
NAME
APPLICANT Roba.f Ki S ler
INFORMATION: Property Owner
(or agent)
TYPE of WORK: RESIDENTIAL: )(
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
Gi4
STREET ADDRESS:
35/0
STREET ADDRESS (INSPECTION LOCATION):
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUcruRE
COMMENTS or FURTHER LOCATION CLARIFICATION: Please attach maD of insDection location)
. 3d ~}:l
INSPECTION
IN FORMATION:
DATE OF INSPECTION:
TYPE OF IMPROVEMENT:
.. UPGRADE SERVICE: From 100 to:;Z 00
a UPGRADE PANEL BOARD(S)
. ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
o NEW METER SERVICE (i.e. Fountain in pond,
Subdivision street or signage lighting; Installation of
new utility services for an area)
DYES
. NO
Number of NEW CIRCUITS: 0
Number of METERS: ()
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
~ /L ~j
nature
2d r.h 6 j fr:A
PRINT
7/;}.0/07
DATE
S:Permits{Forms/Electrlcal Application Apr 2007
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections