HomeMy WebLinkAbout07120104 Applicationa O l D'
City of Carmel/Clay Township 07
T APPLICATION FOR ELECTRICAL INSPECTION
NAME PHONE 31 7 93Y3(o
CONTRACTOR
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O ?iPGf ?r B 317
INFORMATION: street Address city state zip
L O4 6 S r.n Lallx /2,( /1?9?raSvi ? /?r G°
APPLICANT NAME
t CONTACT PHONE:
3/7 -?3/^ 07S`7
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL: f
PROPERTY OWNER NAME(S): PHONE:
PROPERTY AS? Yj Y(p ^ Z ??a
OWNER
INFORMATION:
sTREEr aD Ress:
cnr state Zp
STREET ADDRESS (INSPECTION L _ON): oty state ZIP
INSPECTION -.
INFORMATION:
DATE OF INSPECIIO
TIME OF INSPECTION:
TYPE OF IMPROVEMENT: 5 / f -2L?q 1 MO' ING SERVICE FROM OVERHEAD
UNDERGROUND?
CBUPGRADE SERVICE: From CICU to O YES F?K NO
3?UPGRADE PANEL BOARD(S)
T3 ADDITION, ALTERATION, REMODEL, or.REPAIR TO
SAN 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)
D ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
D CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
Number of NEW CIRCUITS: 10
Number of METERS: 1
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS F RM IS CGWtETE AND ACCURATE.
Igna Are
PRIM j DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
I FEES: $ 104.00 for 4ommercial inspections; .$ 51.50 for Residential Inspections
Application Apr