HomeMy WebLinkAbout19050067 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:
19050067
Cameron Electric 317-547-5474 matt.cameronelectric@gmail.com
4771 N Franklin Road Indianapolis Indiana 46226
MATT BECKOM 317-547-5474
4771 N FRANKLIN ROAD Indianapolis Indiana 46226
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W. 96TH & CLOISTER DRIVE CARMEL,IN
5- 10 19 ✔
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0
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1
Matt Beckom Digitally signed by Matt Beckom
Date: 2018.11.06 10:03:17 -05'00'
Matt Beckom 5-9-19
CAMERON ELECTRIC INSTALLED GROUNDING FOR CABINET AND ELECTRICAL PANEL
ONLY. ALL METERING AND PANEL WIRING DONE BY OTHERS.