HomeMy WebLinkAbout07090126 ApplicationCity of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME QWNG r) PHONE FAX
CONTRACTOR 2 S 7-0 N C-- )
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INFORMATION: street Addreee
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Zip
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NAME CONTACT PHONE:
APPLICANT
INFORMATION: Property Owner
z Contractor
(or agent) OR
_t Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY !'/!i¢2G ?2?SJUn/C n
CQ2?7e L _ 46a ?3
OWNER
INFORMATION:
STREET 'DRESS:
mr #- State
vp
STREET ADDRESS (INSPECTION LOCATION): City State Zip
INSPECTION
INFORMATION:
DATE OF INSPECTION:
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
013 UPGRADE SERVICE: From to
0 UP RADE PANEL BOARD(S) /
VADDITION, ALTERATION, REMODE or REPAIR TO
AN EXISTING ELECTRICAL DI BUION 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
COMMENTS or FURTHER LQC
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES ?O
Number of NEW CIRCUITS: N/A
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS CO PLETE AND ACCURATE.
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Signature
'PRINT , DATE
CLARIFICATION: (Please attach map of inspection location)
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CAtj L;&?-0 7?'7G C/cc762(c.4? .J)-/'C//CC= 10,4AJ?5
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:PenNts/FOrtns/Eledrkal Application Apr 2007