HomeMy WebLinkAbout07110142 Application11/27/2007 12:12 FAX
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° City of Carmel/Clay Tawftship
APPLICATION FOR ELECTRICAL INSPECTION
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MANE PHONE PAX
CONTRACTOR P)cAr4'h, Ci G '
INFORMATION: SWWAddren a+' stow aP
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NAME CONTACT PHONE:
V J E' e oZ - S> a b
APPLICANT -
INFORMATION: Prosy Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER Nwscs): PHONE:
PROPERTY a I
OWNER
INFORMATION: STREET ADDRESS (INSPECTION LO
I-All CblION):
hl C as LP
CG ?C
STREET ADDRESS cw PECn T1ON): Cal' 1 c? state aP
INSPECTION S ?,_ _p
Y`Ct U--. 72
INFORMATION: DATE OF INSPE TIME OF IN ECTION:
TYPE OF IMPROVEMENT:
to
MOVING SERVICE rook vvercneA w
TO UNDERGROUND?
O YES FZ) NO
? UPGRADE SERVICE: From
C7 UPGRADE PANEL BOARD(S) (AFQ BREAKERS REQUIRED]
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
CI NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
? ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
Number of NEW CIRCUITS:
Number of METERS: I
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
Sgrenm
O CONNECTION or RECONNECTION TO A RELOCATED vasNr DAM
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach mm R of Inctioectlon IoOa n)
FEES: $ 93.50 for Commercial Inspections; $ 0 for Residential Inspections
S:PamWFOrnvjE1eC'lo1 APPf43WA OR 2003
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