HomeMy WebLinkAbout07110139 ApplicationCity of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
r? x//013 r
NAME PHONE FAX
CONTRACTOR e5C?lkml-i GL C 62 -D e 'U1
INFORMATION: StreetACdress city State zip
NAME CONTACT PHONE:
APPLICANT ' /
?iCx1 ES 71c?6`7075
INFORMATION: Property Owner
OR Contractor
resentative
R
(or agent) ep
TYPE of WORK: RESIDENTIAL: COMMERCIAL:.
PROPERTY OWNER NAME(S): PHONE:
PROPERTY L.o T o
OWNER
INFORMATION: sntEETADDRESS:
8757 wE,?r??Nr rte. aty
FrsyE,e sate Zip
- YES
STREET ADDRESS (INSPECTION LOCATION): oty State LP
INSPECTION ?? i To 0o
119 R/
1 'E?
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 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
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES O NO
Number of NEW CIRCUITS:
Number of METERS: _L
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
Signature
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
Sa`E 014 -P Zb/rs £s SA/ TW z-Z7V ? &6eIK Suf.
ONTE eoftiF'R DF ?/f02AJG?oa() r ?!/I?5S1SSEiyAc/e /?e
1 % lS A ? e- S% IV IVDTA14 .f/IFTc?? /SASE ?r / lGI ?C PE!)E2 /7 4&
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:PerrnltsjForm_JElectrical.Application Apr 2007
i