HomeMy WebLinkAbout07110123 Application.I of Dqq o ? i i v i,z,-2
2y?HIF . l City of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR c 1? IA1c. 3(3 -,TS2 - Se 3i?-9 ??/S
INFORMATION: Street Addn CRY stare zip
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NAME CONTACT PHONE:
APPLICANT A vvK Aye -- n 3f ' 7? S 2-- !v
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY $JU .-r HOEAS
Cpj AIE-wto 3! Co32- v
OWNER
INFORMATION: ?? ": sate
city Zp
30 to elc' ?SEVEc-T JE ?i???Po+t [ ! /!J YGz(8
STREET ADDRESS (INSPECTION LOCATION): City stare Zip
INSPECTION 15 ct Z f o? Epp ?? (,2,?? L t
INFORMATION:
DATE OF INSPECTIO
/ I
--T
,P,7 TIME OF INSPECTION:
(?'
TYPEOFIMPROVEMENT:
? UPGRADE SERVICE: From to
?' UPGRADE PANEL BOARD(S)
? ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
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)
? CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
? YES X NO
Number of NEW CIRCUITS:
Number of METERS: J--
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPL AND CCURATE.
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Signature
/ • A` /
A ? N /? 'Fr c ? ((/V /d..
PRINT D
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach man of inspection location)
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections