HomeMy WebLinkAbout07110041 Application1 G?,Y RIF
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City of Carmel/Clay Township
My, APPLICATION FOR ELECTRICAL
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MOVING SERVICE FROM OVERHEAD I
TO UNDERGROUND? I
NAME PHONE FAX
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CONTRACTOR oj)e- LLEC /31 C 55L(a "Ogo 5 - r
INFORMATION: Street Address CITY state zip
20S-? C X10c 0U iSJLL72S /? 03?!
NAME CONTACTPHONE:
APPLICANT 'n
< SC (f 0 EN l3 ElQG- CI a 0 $0 ?f
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY 5t-(@- '5260
OWNER
INFORMATION: STREET ADDRESS: City State Zip
(Kb-9 EGE-Oc t -v lIFL O X16033
STREET ADDRESS (INSPECTION LOCATION): City State Zip
INSPECTION G E A/C L
INFORMATION:
DATE OF INSPECTION: `I TIME OF INSPECTION:
TYPE OF IMPROVEMENT: '5?
V UPGRADE SERVICE: From ?Ob to Yod
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)
O ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
O CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
O YES `V NO
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS RM IS OMPLETE AND ACCURATE.
Signeture
C
614
Nov 9 2007 LL
DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
FEES: $ 104.00 for Commercial Inspections $ 57.50 for Residential Inspections
'emits/ForMjEleCrical Appllation Apr 2007
S: