HomeMy WebLinkAbout19100181 ApplicationPERMIT #
CITY OF CARMEL
Application for Electrical Inspection
CONTRACTOR
NAME
PHONE
EMAIL
INFORMATION:
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ADDRESS
CITY
STATE
ZIP
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APPLICANT
NAME
PHONE:
INFORMATION:
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C�IFry
STATE
ZIP
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TYPE Of WORK:
RESIDENTIAL
COMMERCIAL
$12.00 PER INSPECTION ❑
$13100 PER INSPECTION
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PROPERTY
NAME
PHONE:
OWNER
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INFORMATION:
ADDRESS 5.i . Tz�"
03 � �a...r S; —,
CITY
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STATE
ZIP
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INSPECTION
ADDRESS
CITY
STATE
ZIP
INFORMATION:
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DATE OF INSPECTION:
TIME OF INSPECTION;
9-11 'D 10-12
❑
12-2 2x)t
TYPE OF IMPROVEMENT:
UPGRADE SERVICE: From to
71 METER RELOCATION
UPGRADE PANEL BOARD(S)
DITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUTION SYSTEM
NEW METER SERVICE (i.e. Fountain in pond;
Subdivision sheet or signage fighting; Installation of new utility
services for an area)
:!D R.O.W. SIGNAL, SENSOR, MONITOR (Le, Traffic Light)
�I 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.
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IONATURE OV
PRINT DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map a# ins ec�. #ion I� ion]
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