HomeMy WebLinkAbout07110144 Applicationi
City of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
NAME PHONE FAX
hlG mac,
???(
7
T 31?-71?-5?75
CONTRACTOR i
c
,
INFORMATION: Street AcdreSS city state Zip
V Y L? fiY+?J rlYi s
-( Q
7
rl?vj ok ?--? ?!6 2 IN
NAME 1 +
"k L
L
' CONTACT PHONE:
'3 1-7 - -7 1 -?R -s
APPLICANT C?
w V ,
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL•_ COMMERCIAL:
PROPERTY OWNER NAVIE(S): PHONE:
PROPERTY A ` v
OWNER
INFORMATION:
STREET ADDRESS:
6'71 2 (n CX '?hu e
City
N, E
state zip
?Gw+?, ?Q y+ti' y?03 z
INSPECTION SIHEET AODRE55 (INSPECT, ION L OCATI/ON)::
6 -7 0 2Vk(X ftU2MLtt City
??, ,? /J State Zip
CG?mX ?GL? y?03z
-
INFORMATION:
DATE OF INSPECTION: I _ I I a? 0-7
TIME OF INSPECTION:
TYPE OFIMPROVEMENT:
UPGRADE SERVICE: From 0 o to 20D
? UPGRADE PANEL BOARD(S)
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES -b-'NO
Number of NEW CIRCUITS:
Number of METERS: ?
O NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
I CERTIFY I)iAT THE INFORMATION CONTAINED
ON THIS F IS COMPLETE AND ACCURATE.
? ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
? CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
FEES: $ 104.00 for Commercial Inspections; 57.50 f r Residential Inspections
5:Permits/Form.5111ectrical Application Apr 2007