HomeMy WebLinkAbout07100141 ApplicationG`?q of CARryE
City of Carmel/Clay Township 7
M APPLICATION FOR ELECTRICAL INSPECTION
YNOIAN?.%
NAME `` ` PHONE N FAX
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CONTRACTOR - i
INFORMATION: Street Address
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x.23 J ?? 46u3
NAME C? COWACi PHONE:
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APPLICANT
INFORMATION: Property Owner Contractor
(or agent)
OR Representative V
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TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY V v-,Y-+e,Wt C`Z ??cl O`I rl
OWNER
INFORMATION: "ADDRESS:
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? city
State
zip
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SREET ADDRESS (INSPECRON LOCATION): City State Zip
INSPECTION q55 A1w e \ ?1
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INFORMATION a?n^e
:
DATE OF INSPECTION:
Za ('
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
71 UPGRADE SERVICE: From l00 to -C)-Oc)
O UPGRADE PANEL BOARD(S)
O 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)
E, ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
O CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES K NO
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
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PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach mat) of inspection location)
FEES: $ 104.00 for Commercial Ins
57.50 for
Inspections
S:Permits/Form;/Eiectricai Appllcation Apr 2007