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