HomeMy WebLinkAbout08010052 ApplicationUtpF ?RMF
a City of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR
INFORMATION: Street Address city state zip
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NAME CONTACT PHONE:
APPLICANT 317 q1 r{ 6 c(D S
INFORMATION: Property Owner j / Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY ; A-a r 5 44 c.v e- - c,£_ 7S2 -'3- o
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OWNER
INFORMATION:
. STREET ADDRESS: City state zip
0 73 0 5,4,E A1,44-c- o -?3 SS' SYD 1S Z90
STREET ADDRESS (INSPECTION LOCATION): City state 21p
INSPECTION ^ 2!G(?? ??
INFORMATION:
DATE OF INSPE 0
Is L TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
O UPGRADE SERVICE: From 00 to
O UPGRADE PANEL BOARD(S)
MOVING SERVICE FROM OVERHEAD
-zo CO) TO UNDERGROUND?
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O YES cg 1 o
Number of NEW CIRCUITS:
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
COMMENTS or FURTHER LOCATION CLARIFICATION:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
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PRINT ATE
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FEES: $ 104.00 for Commercial Inspections;:.$ 57.50 fqr Residential Inspections
S:Perm1ts1FornuJE1ecb1c3l Application Apr 2007