HomeMy WebLinkAbout07100136 ApplicationG1y 9F Cqq?
Lity of Carmel /Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
IA 11W
NAME PHONE FAX
CONTRACTOR ?, r GccTiiL / 317 867- ?- s17
INFORMATION: street Address city state ZIP f
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NAME cONT CT PHONE: i
APPLICANT G,G r 317
INFORMATION: Property Owner Y Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL: y
PROPERTY OWNER NAME(S): PHONE:
PROPERTY
. rT
OWNER
STREET ADDRESS:
city
state zip
INFORMATION:
1.?77 Tee s A i
STREET ADDRESS(INSPECnON LOCATION): - City State ZIp
INSPECTION Axa
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G AA
INFORMATION:
DAT O INSPE ON,? p? TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
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)
? ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
O CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES C3 NO
Number of NEW CIRCUTfS:
Number of METERS: I
;2-f
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE ND ACCURATE.
Signature
l6orr !'•? >T /0%?9
PRINT DAT?_
ER LOCATION CLARIFICATION: (Please attach map of inspection location)
S:Pertalts/FO VElectncal Application Apr 2007
I FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections