HomeMy WebLinkAbout07120083 ApplicationCity of Carmel/Clay Township
APPLICATION FOR ELECTRICAL eSPECTION
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NAME
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PHONE
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FAX
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31 317-7st
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CONTRACTOR
INFORMATION: Street Address city State zip
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NAME vs} µa=? ,ytin A` _/
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APPLICANT r - ?o Z- e.e . Z 7
INFORMATION: Property Owner
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( Contractor
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TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY tS-hV ?y? U'jr w?
OWNER
INFORMATION: STREET ADDRESS (?1 city
14300 G? Tu?ace `]\VC1- Caf+vtl state
110 zio
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STREET ADDRESS (INSPECTION LOCATION): city State Zip
INSPECTION, Io2( t,.! _ ?-.fN S4-. CourA,ej /W ?jt,:03Z
INFORMATION:
DATE OF INSPECTION: Wi•I t eat( TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
D UPGRADE SERVICE: From
O UPGRADE PANEL BOARD(S)
to
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)
O ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
O CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES fK1 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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PRINT DATE
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FEES: 1'$ 104.00 for Commercial Inspections; $ 57.50 for Resicteliti M3?ctiyns
2007
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