HomeMy WebLinkAbout07120065 ApplicationCity of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
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INFORMATION: so-eec Address City tale Zip
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NAME CONTACT PHONE:
APPLICANT .G.dtwT r/77- 7 6 - -
INFORMATION: Property Owner Contractor
(or agent) Representative y ••
TYPE of WORK: RESIDENTIAL: COMMERCIAL: v
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PROPERTY OWNER NAME(S):
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PHONE:
PROPERTY
OWNER
INFORMATION:
STREET ADDRESS: gy
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ZIP
Z77 d-,e /PCG STict? i? 'tnAr dL/
STREET ADDRESS (INSPECTION LOCATION): City State Zip
INSPECTION //S i.37 v6 39i e Ap~ 6 4-
INFORMATION:
DATE OF INSPECTION: TIME OF INS PECTION:
TYPE OF IMPROVEMENT:
O UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
D ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
O NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
D ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
O CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or/F?UR HER
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MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES O NO
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AN ACCURATE.
Signature
PRINT DATE
CLARIFICATION: (Please attach man of inspection location)
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FEE$: $ 104.00 fof Commercial Inspections; $ 57.50 for Residential Inspections