HomeMy WebLinkAbout07120076 Application/ 4SV of Cqq?
City of Carmel/Clay Township
ate; APPLICATION FOR ELECTRICAL INSPECTION
NAME PHONE FAX
CONTRACTOR ?erv U ?6ct tiwS <::?`:4 6-0-? SS--
INFORMATION: Street Address city ' n state Zip
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NAME. CONTACTPHONE:
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APPLICANT Y
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME( S): PHONE:
PROPERTY C tjel,' 4F Ae'v
OWNER
INFORMATION:
STREET ADDRESS:
rnv scare Zip
Z ( -S s 6 . SA . '0140 [a ;/i1 46674
STREET ADDRESS (INSPECTION LOCATION); city state Zip
INSPECTION --i35 4J- tf6-> k S+ - o4LI(0? 4- 627/;
INFORMATION:
DATE OF INSPECTION
/G ? E OF INS ECTION:
TYPE OF IMPROVEMENT:
O UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
Fr 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)
? ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
O CONNECTION or RECONNECTION TO A REL40CATED
STRUCTURE
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES i? NO
Number of NEW CIRCUITS: _
Number of METERS: I-
I CERTIFY THAT
ON TFJK-FQ.RNV1
COMMENTS or FURTHER LOCATION CLARIFICATION:
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THE INFORMATION CONTAINED
OMPL AND ACCURATE. I
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DATE
h map of inspection location)
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I FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:Perrnits/FO is/Electrical Application Apr 2007