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HomeMy WebLinkAbout08010043 ApplicationCity of Carmel/Clay Township APPLICATION FOR ELECTRICAL INSPECTION NAME PHONE FAX CONTRACTOR c '` r 17 f?? - /L -?' iT J-%S - '?*- J- ',N INFORMATION: Street Address uty state Zip NAME CONTACT PHONE: APPLICANT S ;' C ? ?- INFORMATION: Property Owner Contractor (or agent) OR Representativ U TYPE of WORK: RESIDENTIAL: COMMERCIAL JAN 1 6 ?006 PROPERTY OWNER NAME(S): PHONE: PROPERTY =' 3 71 OWNER INFORMATION- STREET ADDRESS: City State ZIP ,c v fc s / 'L? STREET ADDRESS (INSPECTION LOCATION): City State Zip INSPECTION INFORMATION: DATE OF INSPECTION: 1117/0-7 TIME OF INSPECTION: 1 ?? Z TYPE OF IMPROVEMENT: CCn +%P MOVING SERVICE FROM OVERHEAD TO UNDERGROUND? 7.1:r- UPGRADE SERVICE: From ; 01o to t c? O UPGRADE PANEL BOARD(S) O 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) O ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light) O CONNECTION or RECONNECTION TO A RELOCATED STRUCTURE YES NO Number of NEW CIRCUITS: Number of METERS: I CERTIFY THAT THE INFORMATION CONTAINED ON THIS FORM IS COMPLETE AND ACCURATE. Sigrature PRINT ! DATE COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location) FEES: $ 104.00 for Commercial Inspections; $ 57.Sofor Residential Inspections S:Permits;Fomts/Efectrtcal Applicator Apr 2007