HomeMy WebLinkAbout07120082 Application-- OF CA.9
City of Carmel /Clay Township
n > %' APPLICATION FOR ELECTRICAL INSPECTION
/-_I0N -? 1)-7 / 17i ocO
NAME PHONE FAX
CONTRACTOR
INFORMATION: Street Address city state ZIP
NAME RYt i t ?C ?1 ,? CONTACT PHONE:
APPLICANT 13 ?? l av 2.0 q1 -
INFORMATION: Property Owner / Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: v COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROP
TM ck-" JSICLL Tlq?qste(
R
OWNE
INFORMATION:
STREET ADDRESS:
city State
ZAP
STREET ADDRESS (INSPECrION LOCH ON): Qty State ZIP
INSPECTION 1
INFORMATION:
DATE OF INSPECTION:
ME OF INSPECTION:
M
TYPE OF IMPROVEMENT:
O UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
J? ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
1 QQCk I cAVSrki(Nq p'lih6a)isu
O 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
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
? YES k NO
Number of NEW CIRCUITS:
Number of METERS: I
i
I CERTIFY THAT THE INFORMATION CONTAINED
kNH M IS COMPLETE A ND ACCURATE.
1 0'7
DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach may of inspection location)
Lr?. ^. -t - _.._.,._ 1 -An Is%" S _'.0, ^-, - I. A t__!A, 1 r4 ii fll,n,n np-t,- i
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:PennlWFoms/Electrlcal Applkation Apr 2007