Loading...
HomeMy WebLinkAbout07090045 ApplicationCity of Carmel/Clay Township I APPLICATION FOR ELECTRICAL INSPECTION -t 07CqMqS- NAME PHONE FAX CONTRACTOR A/^?c?oh ?`CC?n . Nom. 5- y,Z-5/7 _5 INFORMATION: street Address{? // L/N n * A,.v A Y7 I state LqI/C e uJYG zip N ME CONTACT PHONE: A l ? ? ?e 7 - S y7/1' APPLICANT e c c v?+ l/ [ / c , - INFORMATION: Property Owner Contractor ti y R (or agent) OR ve epresenta TYPE of WORK: RESIDENTIAL: zl/ COMMERCIAL: PROPERTY OWNER NAME(S): PHONE: PROPERTY T/+ 0'1119nD 233-337--) INFORMATION: STREET ADDRESS: city State ZIP )/5-00 ,S/i CG13c?"n,vc 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) /6U /}j?f s'eie vi ? e O h (./c?c.... /j ?lJ2 G i3f e /t'IuTa?ti, FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections S:Perrnits/Forrns/EIecCical Appkatlon Apr 2007