HomeMy WebLinkAbout07100107 ApplicationCity of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR - - ! ooe-
INFORMATION: SUeet Address cry state Zip
NAME CONTACT PHONE:
APPLICANT
INFORMATION: Property Owner Contractor
(or agent) OR Representative Ll?
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY
Tti
OWNER
INFORMATION: MEET ADDRESS: City State ZIP,
/-?71 r'ST 57, e ` ?? .. e"
STREET ADDRESS (INSPECTION LOCATION): City state 7Jp
INSPECTION L e /? L Atin?
INFORMATION:
DATE OF INSPECTION: TIME OF INSPECTION:
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Z
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
D 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)
O CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
O YES O NO
Number of NEW CIRCUITS:
Number of METERS: L
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
Si9nahire i
PRINT DATE
COMMENTS 'or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
J L/4L!/(/<S/W ? ??3!///tJ ? S ?j +?®r1J L G
FEES: $ 104.00 for Commercial Inspections; $ S7.S0 for Residential Inspections
S:PeffnWFormslE1ecWca1 Application Apr 2007 SCANNED