HomeMy WebLinkAbout07090044 Application? 6r/lJ 90 D?
City of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR ,
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INFORMATION: Street Address cty State zip
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NAME CONTACT PHONE:
APPLICANT r u Z?17. `?71, S?
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY ( , /? L" (3E-, 3( 7 - S73 • `/ 79'J I
OWNER
N:
INFORMA
ADDRESS:
STREET
city state
.
ZIP
7 Il (03`? A J? ??L-- / Lf(o032-
STREET ADDRESS (INSPECTION LOCATION): CRY State Zip
INSPECTION `f?032-
INFORMATION:
DATE OF INSPECTION: ?aJf
TIME OF INSPECTION:
TYPE OF IMPROVEMENT: Pik-
UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
W/ ADDITION, 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)
O ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
O CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES O / NO `
I?
Number of NEW CIRCUITS: -
Numberof METERS: _4;?-
I CERTIFY AT THE INFORMATION CONTAINED
ON THIS PRAM IS 7nPACCURAT
E.;sign e
/r?oTh-y ?'1rGfG 5/?•07
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach mat) of inspection location)
FEES: $ 104.00 for Commercial Inspections $ 57.50 fo Residential Inspections
i:Pe.^r WFC. ^?/.Eilec dcal Application Apr 2007 ?