HomeMy WebLinkAbout07090091 ApplicationGSy oe CgghF -}? / I / V ? U V ?'
I! 9.T3Nl ( ? City of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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CONTRACTOR NAME s C
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C PHONE 2 1 FAX
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INFORMATION: Street Address
1??55?? ?, aty sate zip
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ONiACi PHONE:: C ('
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APPLICANT
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY PROPERTY OWNER NAME(S):
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OWNER
INFORMATION: STREETADDRESS:
the
Cry state Zip
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INSPECTION STREET ADDRESS (INSPECTION LOCATION)
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INFORMATION
: DATE OF INSPECTIO
,,,;),TIME OF INSPECTION:
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33
TYPE OF IMPROVEMENT: MWING SERVICE FROM OVERHEAD'
?O UNDERGROUND?
D UPGRADE SERVICE: From to
D UPGRADE PANEL BOARD(S)
O YES O NO
Number of NEW CIRCUITS:
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
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
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS PL?E AND ACCURATE.
Signature
Pw ( Sk'?e f(o? ?. 4 1 ), 1
PRINT DATE
COMMEUTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
FEES: $ 104.00 for Commercial Inspecti s; $ 57.50 fob esidential Inspections'
^ermWFOmS/Elecaiul Appllution Apr 2007 -
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