HomeMy WebLinkAbout07110117 ApplicationyZ.RT?lryp :.
:City of Carmel/Clay Township ?7 ?I I
APPLICATION FOR ELECTRICAL INSPECTION
NAME PHONE FAX
CONTRACTOR c T IA/C. 301 -75-7- -?T-5_e5 - 31'*- -1te-9 XIS
INFORMATION: stns Ad&re CILy state Zip
-i s O$ ' TLE Lz &cEpz . Ave M/SV?r ? E I 'YeQ0
NAME - CONTACTPHONE:
APPLICANT` Aa vv1 t C.F( . 5(7 -?SZ-lv
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY -B. -r HC)US Af6 c ?.n 3r -X32 - v
OWNER
INFORMATION:
"DRESS'
oh` State
ZIP
5030 QoaSEVEe_T ?E yJArAPUA " (^j d(GZl
STREET ADDRESS (INSPECTION LOCATION): City. stalE zip
INSPECTION Z Tar.J
14 o? Z
TC Dr
INFORMATION:
DATE OF INSPE T
jt TIME OF INSPECTION:
o21
TYPE-6.04' PROVEMENT: \-? -
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O UPGRADE SERVICE: From to
O' UPGRADE PANEL BOARD(S)
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DTSTRIBUION SYSTEM
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)
? CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
O YES K NO
Number of NEW CIRCUITS:
Number of METERS. 1-
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLVM A YD ACCURATE.
Sign^?ature(r - ,{ '
A a-W., /' l &_ Trc (( LI o?
PRIM
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspectfon'location)
?S c ?S ?o w zVL S.A? Pt, y C.y°ct>' 1 rs t 'T r-T E X ? "Ty
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FEES:. $104.00 for Commercial Inspections; $ 57.50-for Residential Inspections