HomeMy WebLinkAbout07090045 ApplicationCity of Carmel/Clay Township I
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR A/^?c?oh ?`CC?n . Nom. 5- y,Z-5/7 _5
INFORMATION: street Address{? //
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INFORMATION: Property Owner Contractor
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(or agent) OR ve
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TYPE of WORK: RESIDENTIAL: zl/ COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY T/+ 0'1119nD 233-337--)
INFORMATION: STREET ADDRESS: city State ZIP
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STREET ADDRESS (INSPECTION LOCATION): Qty State Zip
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
M?- NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area) E gte ?'?2'"?
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 g--,NO
Number of NEW CIRCUITS: -3
Number. of METERS: _L
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
S/Iinature
PRIPrr DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
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FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:Perrnits/Forrns/EIecCical Appkatlon Apr 2007