HomeMy WebLinkAbout07110122 Application=4
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0000i I O= yIANa A " 1 City of Carmel /Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
N
NA14E PHONE FAX
CONTRACTOR 1? - In1?. 3t} -75-2 - 59 - 31}- -+I-9 1,45-
INFORMATION: Street Aamess ow state ZIP
lS 5 'f-c t?E CQEE Alec -^Mvu- f 1407-7
NAME CONTACT PHONE:
APPLICANT AD v?1 E c-ff 3f-f -4t52--Iv
INFORMATION: Property Owner Contractor
?
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: v
COMMERCIAL: A
PROPERTY OWNER NAME(S): PHONE:
PROPERTY Brz1 &VI T se E- 3f -ra32- v?
OWNER
INFORMATION: STREET
ADDRESS:
City State
ZIP
530 ,2no5EVEt=r ?E 1NAtPo?A L! /!? A(Gu8
STREET ADDRESS (INSPECTION LOCATION): City State Zip
INSPECTION (? D FEt2r.ILCA ILv
INFORMATION-
DATE OF INSPECTI ? TIME OF INSPECTION;
U II
TYPE OF`IMPROVEMENT:
O UPGRADE SERVICE: From to
CD UPGRADE PANEL BOARD(S)
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN BASTING ELECTRICAL DISTRIBUION 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?
C3 YES X NO
Number of NEW CIRCUITS:
Number of METERS: J--
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maa of inspection location)
t ,E-v.s PO t? 1 1W-- !E?LA P iPL--Y L? t3 i N E T hst?- K t ei
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FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections