HomeMy WebLinkAbout07100085 ApplicationGSr OF CA/Igzr,
=?? ` }} City of Carmel/Clay Township?0 I D DDS
d ; f APPLICATION FOR ELECTRICAL INSPECTION
NAME PHONE FAX
CONTRACTOR = - r 317 >'?f /7 G? /tee
INFORMATION: Street Addresa Qty state zip
Vr'o
NAME
- cONr cT PHONE:
I
APPLICANT G r
INFORMATION: Property Owner / Contractor
(or agent) j/ OR Representative .
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY
'
OWNER
INFORMATION: STREET ADDRESS: Qty State LP
77 Z/
STREET ADDRESS (INSPECTION LOCATION): Qty 97 State 2Jp
INSPECTION r-- 6vrxrG
INFORMATION:
DATE OF INSPECTION: TIME OF INSPECTION:
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GG 6G Gl?if? Da><<-
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
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
O YES O NO
Number of NEW CIRCUITS:
Number of METERS: _ I
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
Signature
c--Q?7i' /7
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach mati of inspection location)
!/i7 /;aP ?fli/v SCANNED
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:Penlts/Foms/Electrical Application Apr 2007