HomeMy WebLinkAbout07110119 Applicationj. City of Carmel/`Clay Township
y ' APPLICATION FOR ELECTRICAL .INSPECTION
NAME PHONE FAX
CONTRACTOR -fit c ; (A1c. 313- - 59 311 _+"7 60119
INFORMATION: StreetAddrem city sratE Zip
't s.. $ ' Te-c c.6 62EE Ave w+SJa.r_E I t'l fee T
NAME CONTACTPHONE:
APPLICANT' A'D cv-, PtAy6mcff Sf 5 2- 1051
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY ?aj -r SF' Af6 u-O
atj 3t -?32- ?'
OWNER-
INFORMATION:
ADD
state
nP
3?3o QonSEVEt_T ?E nrl?esW ct I!? A(GZIE>
STREET ADDRESS (INSPECTION LOCATION): city state - ztP
INSPECTION 2.4-5 Z LAS I O ? '' c? yZ tµt L
INFORMATION:
DATE OF INSPECTION'
TIME OF INSPECTION:
TYPE-604'k- PROVEMENT:
O UPGRADE SERVICE: From to
O' UPGRADE PANEL BOARD(S)
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
t' AN.EXISTING ELECTRICAL DI5TRIBUION 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)
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 COMP AN ACCURATE.
SigNIMM
-Al.•n /Ire-
PRINT DATE
COMMENTS'or FURTHER LOCATION CLARIFICATION: (Please attach map of inspeCt on location)
>J E? ?oT.c SuT?F?W c.43cart T e-F4
(_ E 14-
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections