HomeMy WebLinkAbout07110137 ApplicationCity of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAMc" PHONE FAX
CONTRACTOR 72/e2 'D S y/X
INFORMATION: Street Address Qty state zip
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NAME C NTAcT PHONE:
APPLICANT s - S 7 O 7.2
S
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:.
PROPERTY OWNER NAME(S): PHONE:
PROPERTY F? V % rJa ??o f5
OWNER
INFORMATION: sTREErnooaess: city scare zip
9 !r sW Res I.tJ
STREET ADDRESS (INSPECTION LOCATION): City State Zip
INSPECTION
/ Zs SSL/JAuIA
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INFORMATION:
DATE OF INSPECTION: TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
O UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISfRIBUION SYSTEM
?Z 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
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES O NO
Number of NEW CIRCUITS: '2-
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED.
ON THIS FORM IS COMPLETE AND ACCURATE.
signature
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PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION:
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FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:Pernitsi Forms!Electricai Applicatlca Apr 2007