HomeMy WebLinkAbout18040203 ApplicationS:\Permits\FORMS\Active Forms Binder (Copyable Form Orginals)\Applications\2018 Electrical Inspection Application.doc
Permit # _________________________
CITY OF CARMEL
Application for Electrical Inspection
CONTRACTOR
INFORMATION:
NAME PHONE EMAIL
CONTRACTOR ADDRESS CITY STATE ZIP
DATE OF INSPECTION: TIME OF INSPECTION:
_______/_______/________ 9-11 10-12 12-2 2-4
PROPERTY OWNER ADDRESS CITY STATE ZIP
RESIDENTIAL COMMERCIAL
$71.00 PER INSPECTION $131.00 PER INSPECTION
APPLICANT ADDRESS CITY STATE ZIP
NAME CONTACT PHONE:
APPLICANT
INFORMATION:
PROPERTY
OWNER
INFORMATION:
TYPE of WORK:
TYPE OF IMPROVEMENT:
UPGRADE SERVICE: From _______ to _______
METER RELOCATION
UPGRADE PANEL BOARD(S)
ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUTION SYSTEM
NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of new utility
services for an area)
R.O.W. SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
MOVING SERVICE FROM OVERHEAD TO
UNDERGROUND?
YES NO
Number of NEW CIRCUITS: _______
Number of METERS: ______
I CERTIFY THAT THE INFORMATION CONTAINED ON THIS FORM IS
COMPLETE AND ACCURATE.
SIGNATURE
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
__________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________
PROPERTY OWNER NAME PHONE:
INSPECTION ADDRESS CITY STATE ZIP
INSPECTION
INFORMATION:
18040203
Cameron Electric Inc 317-547-5474 matt.cameronelectric@gmail.com
4771 Franklin Road Indianapolis IN 46226
Matt Beckom 317-547-5474
4771 N Franklin Road Indianapolis IN 46226
✔
Lisa Scroggins
4487 W. 131st Street Carmel In 46074
4487 W. 131st Street Carmel IN 46074
515 2018 ✔
✔
Matt Beckom 4-18-18
Installing new 200amp service on existing dettached garage