HomeMy WebLinkAbout07080151 Application
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City of Carmel! Clay Township 070 /
APPLICATION FOR ELECTRICAL INSPECTION
NAME PHONE "78 7 "(J 7 eft Lf FAX
CONTRACTOR Rl'f'l I:< (C 1/'fC/
INFORMATION: Street Address Oty State Zip
1 ?- -0 Io~ tv r ST 7
NAME CONTACT PHONE:
APPLICANT 1(673 NdCI-{ )
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY 513<::... J (('PI Ir "'/r}JO)...l (NP
OWNER
INFORMATION: STREET ADDRESS: City State Zip
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City
( (
SWEET ADDRESS (INSPECTION LOCATION):
State
Zip
INSPECTION
INFORMATION:
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
06 NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DiSTRIBUION'SYSTEM
4 NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
Number of METERS:
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.,
JJ~7~ "
Signature
G- ( I-- L \'?. r p, I t T '1> - )~-O 7
PRINT DATE
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTSor.FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
8A-~t <; (Dr; >'1-(U~-li5...T C.O'P-NG-K (f) F Lv~~To!' P"17\I1"'DA
FEES: $ 104.00 for Commerciallnspectionsi $ 57.50 for Residential Inspections
S:PermltsjForms/Electrlcal.Applicatlon Apr 2007