HomeMy WebLinkAbout07100093 ApplicationCity of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
1V':7/ /In(9 C3
NAME PHONE FAR
g67-130
CONTRACTOR
INFORMATION: Street Add City State ZIP
/
7`I-tea ?C.S-3 /T/• S" l,</ .1/?/ X07/
N CONTACT PHONE:
?6oS'
APPLICANT
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: COMMERCIAL:
OWNER
PROPERTY ER NAME S): PHONE:
PROPERTY 5'(_ g6®2/
OWNER
INFORMATION:
STREET ADDRESS:
aty State
zip
STREET ADDRESS (INSPECTION LOCATION): City Rate Zip
INSPECTION S lO?o A" 6;zS0
INFORMATION:
DATE OF INSPECTION:
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O UPGRADE SERVICE: From to
fI/ O YES ?O
O UPGRADE PANEL BOARD(S) IV, Q n V /1
?? Gam' Number of NEW CIRCUITS:
(DDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM Number of METERS:
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 CLARIFICK
I CERTIFY THAT THE INFORMATION CONTAINED
ON3HIS,F? COMP ETE AND CCURATE.
51((g//n?a,,Nre? ?))
p9d.??sH?yc?GH /0-A`67
PRINT DATE
: (Please attach map of inspection location)
FEES: $ 104.00 for Commercial Inspectio6s; $ 57.50 for Re0ential Inspections
S:Perrn1WFo"s/E1ectrica1 Applicadon Apr 2007