HomeMy WebLinkAbout07080197 Application: ,a S, pFe City of Carmel/Clay Township I
i
APPLICATION FOR ELECTRICAL INSPECTION
?`DIANpNAME \ PHONE, F?[J(
CONTRACTOR 4--Z?10 - 2QL? Z -7 IS - 1a ?-1 to
INFORMATION: Street Address city State I zip
L(lO otzCk
NAME CONTACT PHONE:
APPLICANT o, L z-,., 3d L ? - 2 L?
INFORMATION: Property Owner Contractor
?
OR Representative V--
(or agent) Il
/
TYPE of WORK: RESIDENTIAL: COMMERCIAL: i
PROPERTY OWNER NAME(S): PHONE:
PROPERTY
OWNER
'
INFORMATION: ap
sTRE?rADDRESS: otY state
IFS W . Cwt .mac - gle 0 ?a
STREET ADDRESS (INSPECTION LOCATION): city State Zip ?-1toQ
INSPECTION \
INFORMATION:
DATE OF INSPECTION: TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
O UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
-/AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
CY NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES 'NO
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION
ON THIS FORM IS COMPLETE AND A
? ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
O CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
Signature
}
Ll-' -r zwcccz` ?173? 0-1
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
`J2?Tw e. e-, \3? -V l?k\ S?- 6th W 25? ?1\4
?10 AM 1r^?X 2A ?az c? c? S? t? ` r ?oc?a
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:Permlts/Forms/Electrical Application Apr 2007