HomeMy WebLinkAbout07110127 ApplicationCity of Carmel/Clay Township
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APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR 1? lnJc. 3t3- -3?S2- - 58 3t?-9 415-
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NAME CONTACT PHONE:
APPLICANT AD Y?l E c-I'f
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY
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OWNER
INFORMATION: "ORESS. City state zip
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STREET ADDRESS (INSPECTION LOCATION): CRy State Zip
INSPECTION 85? („jt>(A-rj e ?d? (AJ
INFORMATION:
I DATE OF INSPECTION: I I ??
TIME OF INSPECTION:
TYPE OF IMPROVEMENT: I -------J
O UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
O 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)
O ROW SIGNAL, SENSOR, MONITOR (Le, Traffic Light)
O CONNECTION or R€CONNEC ON TO A RELOCATED
STRUCTURE
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES x NO
Number of NEW CIRCUITS:
Number of METERS: J--
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND A CU TE.
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