HomeMy WebLinkAbout07100001 ApplicationOF C:AA.
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City of Carmell Clay Township
APPLICATION FOR ELECTRICAL FNTSPECTION
INDIAN? O 00
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NAME PHC FAX.
CONTRACTOR 300± _ (""" / 38
INFORMATION: 4 str=etAda?? city
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NAME
k WNT PHONE:
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APPLICANT
INFORMATION: Property wner Contractor
(or agent) / 0R Representative
TYPE of WORK: I RESIDENTIAL: COMMERCIAL:
PROPER„ OWNcrc ' E(s): 'HONE:
PROPERTY A&if
OWNER
INFORMATION:
R s N sate zlv
ST FEE ET AD v (IN P i ON LOCAT N): I Gry State ZIP
INSPECTION
INFORMATION:
DATE IO I I E? ON: M OF INSP ECTION:
,07 . S ( Ill
TYPE OF IMPROVEMENT:
MOVING SEKVICE rKUM UVrKm CA6v
TO UNDERGROUND?
O UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
CD .4DDFION,.4LTERATION, REMODEL, orREPAiR TO
SAN xSTING ELECTRICAL DISTFSBUION SY?M
Yl NEv" METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; installation of
new uti;ity services for an area)
n ROW SIGM4L, SE .SOR, MONITOR ;i.e. Tramc Light)
CONNECTION or RECONNEC-i!ON T O A RELOCATED
STF.UCT URE
O YES P 'NO
Number of NEW CIRCUITS:-
Number of METERS: I
I CERTIFY Tr;AT i HE IN FORYiA T ION CONv T AINED
ON Tr.-IS FORM IS CO . LETE AND .ACCURATE-
sigratum A
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach rnao of inspection location)
FEES: $ 204.00 for Commercial Inspections; S 57.50 for Pesidential Inspections
=.is.=m/-pr.,+VEe -l App6.at= A.c 2007
SCAJI,, IA ED