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City of Carmel/Clay Township
- n APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR c T Iw1C• 3i? - 59 3i?-9 !o?/?
INFORMATION: street Addres mot' state TIP
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N CONTACT PHONE:
APPLICANT A
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INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAMEM: PHONE
PROPERTY -r Hc"s E 31 - C. 32 - 07
OWNER
INFORMATION: ??ADD?` sore
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3030 IecoSEVE(-r JE r'ijr>r/i++IA & ln/ A(GZlQ)
STREET ADDRESS (INSPECTION LOCATION): City state ZIP
INSPECTION 3-zq s "J f 3 S r S % c_A-oe_ ?*! L Aj
INFORMATION: DATE OF INSPECTIO !?? ?( TIME OF INSPECTION:
TYPE-OF=IMPROVEMENT: DVING SERVICE FROM OVERMEAD
TO UNDERGROUND?
O UPGRADE SERVICE: From to
O YES X NO
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 (i.e. Traffic Light)
O CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
Number of NEW CIRCUITS:
Number of METERS: J--
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS C MPLETE ND A PRATE.
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PRINT DA
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)