HomeMy WebLinkAbout07110063 Application1 G`.?:? eF C`gq?F! ?V ? l 0 V
City of Carmel/Clay Township
,-' APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
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941 7/7) '//'l- ?roSE
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CONTRACTOR , _
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INFORMATION: Street Address city state Zip
?s S f/?cK opt ?? ,do cS ?'.J la 317
NAME CONTACT PHONE:
APPLICANT (Y/7 ?//fL ??S t!
INFORMATION: Property Owner Contractor
(or agent) OR Representative_
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY 'd C",;/ le FUFc.?Plh1 N Sly
OWNER
INFORMATION: STREET ADDRESS: city State Zip
2. f C. /'/LeW /)7 FU k67 t/MC-C T? Y?a
STREET ADDRESS (INSPECTION LOCATION): City State Zip
INSPECTION 30 0 PETT/ Z? U/ 03 2
INFORMATION:
DATE OF INSPECTI
/
( TI OF INSPECTION:
II
)
0 F2=
TYPE OF IMPROVEMENT: ?? MO SERVICE FROM OVERHEAD
UNDERGROUND?
O UPGRADE SERVICE: From to O YES O NO
O UPGRADE PANEL BOARD(S) ?,?
Number of NEW CIRCUITS: 1 ?/
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM Number of METERS:
NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
? ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
O CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM I?S\COMPLETE `AND ACCURATE.
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Signature
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PRINT DATE /
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
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FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections F
S: Permits/Forms/Electrical Applic.tion Apr 2007