HomeMy WebLinkAbout07080003 Application
City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR 6 tit< nVtf~ /~(! '-" Ttf'I'- ") 71 -7t/J
INFORMATION: Street Address City State Zip
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NAME CONTACT PHONE: ?lJ. 71. ,,3 - 1.-/
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APPLICANT J ( 791J -:17/ ./- c..
INFORMATION: Property Owner Contractor
(or agent) OR Representative
.
TYPE of WORK: /'
RESIDENTIAL: COMMERCIAL:
.
PROPERTY OWNER NAME(S): PHONE: I
PROPERTY C/l1( Y ;? <<N YfI rT ,j'lt-}j()/ I
OWNER
INFORMATION: STREET ADDRESS: Oty State Zip
)'H3 If /'(" 171 J r , ,):/U6 ~J;(-\;/I["''-'! ..1;.,1 f.!jf/?7-.
STREET ADDRESS (INSPECTlON LOCATION): City State Zip
INSPECTION rJ., J? k /"1(,. ,Il' sr, /I(u 111 (..{'5Jv; <.<-6 J:/'f 'Ie II" 2..
INFORMATION:
DATE OF INSPECTION: TIME OF INSPECTION:
TYPE OF
PROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
UPGRADE,SERVICE: From
to
DYES
o NO
o UPGRADE.PANEL-BOARD(S)_._
~ TERATION, REMOD~~~'~~';;'~------:::'
AN EXISTING ELECfRICAL DISIRIBUI0N-SYSTEM
-'
---- ----
- 0 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:
Number of METERS:
,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE,I
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SIgnature /
,rh/;/
DATE
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCfURE
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PRINT
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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I FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:Permlts/Forms/Electncal Application Apr 2007