HomeMy WebLinkAbout07110130 Application
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City of Carmel /:Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME - PHONE FAX
CONTRACTOR c T IIJC- 31} -752 - S9 - v1* -9 wlj -
INFORMATION: Street Address city state Zip
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NAME CONTACT PHONE:
APPLICANT A wt - C-fr . 3(7 '-,7-52--!v
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:.
PROPERTY OWNER NAME(S): PHONE:
PROPERTY 3f C. 32- ?0 -F
OWNER
INFORMATION:
srREETaoDRESS:
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STREET ADDRESS (INSPECTION LOCATION): Qty state ZJp
INSPECTION S J?yQ? 1 tcK QD G tZ (PJ
INFORMATION:
DATE OF INSPECTI
I I Z? TIME OF INSPECTION:
TYPE OF'"IMPROVEMENT: OVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O UPGRADE SERVICE: From to O YES X NO
O UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM Number of METERS: 1.-
X 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
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS MPLETE A D A RATE.
C
Signature
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
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I FEES: $ 104.00 for Commercial Inspections; $ 57.50 for ResidentiaT Inspections