HomeMy WebLinkAbout07100087 ApplicationCity of Carmel/Clay Township 6 q i 0 0 g T
APPLICATION FOR ELECTRICAL INSPECTION
NAME PHONE FAX
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CONTRACTOR r.?T Et[sC
INFORMATION: Street Address City State zip
NAME CONTACT PHONE:
APPLICANT ?r d r c'• . , r l i7 -975
INFORMATION: Property Owner Contractor
(or agent) t/ OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:.
PROPERTY OWNER NAME(S): PHONE:
PROPERTY
r? r
OWNER
INFORMATION: sTtEETADaRESS: ary state ZIP
STREET ADDRESS (INSPECTION 'LOCA7I0N): city state ZIP
INSPECTION ? Z &,-. /x/rW STYE r1.:arrG ?iw•,??1
INFORMATION:
DATE OF INSPECTION: TIME OF INSPECTION:
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TYPE OF IMPROVEMENT:
MOVING:SERVICE FROM OVERHEAD
TO UNDERGROUND?
C UPGRADE SERVICE:' From to
O UPGRADE PANEL BOARD(S)
D ADDITION, ALTERATION, REMODEL, or REPAIR TO
/r AN BUSTING ELECTRICAL DISTRIBUION SYSTEM
L? 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)
C CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
D YES D NO
Number of'NEW CIRCUITS:
Number of METERS: !
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
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COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
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FEES: $ 104.00 for Commercial Inspections; $-57.50 for Residential Inspections