HomeMy WebLinkAbout07090130 ApplicationCity of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR L14LA &-7
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INFORMATION: street Address aty state tip
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NAME CONTACT PHONE:
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APPLICANT e.
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INFORMATION:
Properry.Owner /
Contractor
(or agent) OR Representative
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TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY : ?- Peak i.
OWNER
INFORMATION:
sTREET ADDRESS:
City
State
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30 S. ri :dam sue; -
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STREET ADDRESS (INSPECTION LOCATION): aty State Zip
INSPECTION f
INFORMATION:
DA OF INSPECTION:
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
O UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
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
COMMENTS or FURTHER LOCATION
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a S hr .? w il?dti (765) 3 ?? - %2 S?9
I FEES: $ 104.00 for Commercial Inspections; $ 57:50 for Residential Inspections
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES cuY
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
Signature
G?-ar z 44,14,Aell 9u-o7
PRWr DATE
TION: (Please attach map of inspection location)
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s:Pemn WFonns/ElecMcai Application Apr 2007