HomeMy WebLinkAbout08010061 ApplicationCA
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City of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR , Z-r l r?/ 3i7 86:9 T9:-V 3?7 86a-oa a "
INFORMATION: sreet Address City state zip
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NAME CONTACT PHONE:
APPLICANT ?r-? ?'> C ?? >r 17
INFORMATION: Property Owner Contractor
(or agent) OR Representative 4, -W4.-
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY
r
OWNER
INFORMATION: ?pDDS` City state zip
STREET ADDRESS (INSPECTION LOCATION): City State ZIP
INSPECTION ?? S - u/ ,? ?, • A.-•.? ?L ?%o?
INFORMATION:
DATE OF INSPECTION: TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
O UPGRADE SERVICE: From to
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
COMMENTS or
CLARIFICATION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES O NO
Number of NEW CIRCUITS:
Number of METERS:. -
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
Signature
TT ?
DATE
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:PermlWForms/Eledd al Appkation Apr 2007