HomeMy WebLinkAbout07110135 Application/ 4sy of CgR?F`
City of Carmel l clay Township 0 7 0 o 3 5
APPLICATION FOR ELECTRICAL INSPECTION
NOIANp
NAME PHONE FAX
CONTRACTOR T IAIC • ?!? -7?5-2 -?* 5-8 3!x -9 AIS-
INFORMATION: Street Address aty stare Zip
is o$ T&-E t-E G2EE AvE a?SVC.iE I/? 14077-
NAME CONTACT PHONE:
APPLICANT A rvt Aye --n '3('f -7-52-ty
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL: -
PROPERTY OWNER NAME(S): PHONE:
PROPERTY B -r Htp&AS4F E- 31 :it -Co32 - v
OWNER
INFORMATION:
STREETADDREss.
City
Stare
71p
$4> -to QnenSEVEt_T JE ?eJAfAN t1 In./ AJ&ZI8)
STREET ADDRESS (INSPECTION LOCATION): CRY State vP
INSPECTION 139 - t' e ? WZCL /~J
INFORMATION:
DATE OF INSPECTI
I Vat- 1 /
- TIME OF INSPECTION:
FROM OVERHEAD
TYPE OF'IMPROVEMENT: 5? -2 =GROUND?
O UNDERGROUND?
O UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
O YES K NO
Number of NEW CIRCUITS:
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
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
Number of METERS: J--
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS OM ACCURATE.
Sign/a?ture I , A I l
/`t do w. /t/l?l?tic 1(/zf167-
PRIM DATE
VENTS or FURTHER LOCATION CLARIFICATION: Please attach ma of in a on_ 1 t n)
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections