HomeMy WebLinkAbout07110134 Applicationi 4?tN of CAq
City of Carmel/Clay Township
1
n. APPLICATION FOR ELECTRICAL INSPECTION
?NDIANP ...._.;_r-
NAME PHONE FAX
CONTRACTOR , Wc. 5a -7572 -:R-S-0 3(a- ?-9 4445-
INFORMATION: saed admess city sate vP
-ts. OS TLE g-A Gi-c 6ecciir, Ave -wsVA-LE (tJ 4&e -T
NAME CONTACT PHONE:
APPLICANT' LTD VVx - c ff sI - ?5 2- Lv
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:.
PROPERTY OWNER NAME(S): PHONE
PROPERTY ?.JU -r Ffe4ASC
Gtj E-wo 3r -1032- ?'
?
OWNER
INFORMATION:
srRETAO°
°??
LP
$c 3o IeonSEVEe_i .!E itOtJb,FA t1 NA/ -qGUe)
STREET ADDRESS (INSPECTION LOCATION): City SRaw - ZJP
INSPECTION 2-410 L-Jitjr
-' -
INFORMATION:
DATE OF INSPE
ME OF INSPECTION:
TI
TYPE-0 F?IM i` `PROVEMENT:' MO NG SERVICE FROM OVERHEAD
? -?
UNDERGROUND?
O UPGRADE SERVICE: From to
O' UPGRADE PANEL BOARD(S)
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
`, AN:EMSTING ELECTRICAL DISTRIBUION SYSTEM
® NEW METER SERVICE (i.e. Fountain in pond;
LL, "` "` 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
O YES 0< NO
Number of NEW CIRCUITS:
Number of METERS: J--
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM COMP UElt AN ACCURATE.
Signature _'7
A V'> +°?l L ft / V7-
PRINT D
COMMENTS or FURTHER LOCATION CLARIFICATION:
FEES: $ 104.00 for Commercial Inspections; $ 57.50-for Residential Inspections