HomeMy WebLinkAbout19110032 ApplicationS:\BCS Current Handouts\2018 Applications\2019 Electrical Inspection Application.doc
PERMIT # __________________
CITY OF CARMEL
Application for Electrical Inspection
CONTRACTOR
INFORMATION:
NAME PHONE EMAIL
ADDRESS CITY STATE ZIP
DATE OF INSPECTION: TIME OF INSPECTION:
_______/_______/________ 9-11 110-12 12-2 2-4
ADDRESS CITY STATE ZIP
RESIDENTIAL COMMERCIAL
$72.00 PER INSPECTION $133.00 PER INSPECTION
ADDRESS CITY STATE ZIP
NAME 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)
__________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________
NAME PHONE:
ADDRESS CITY STATE ZIP INSPECTION
INFORMATION:
19110032
Mister Sparky 317-874-8748 Kenneth.Jackson@authoritybrands.co
4040 Industrial Blvd.
Indianapolis IN 46254
K. Jackson
317-874-8748
4040 Industrial Blvd.Indianapolis IN 46254
✔
Richard Leonard 317-407-7449
11329 Moss Dr.
Carmel IN 46033
11329 Moss Dr.
Carmel IN
46033
11 13 2019 ✔
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0
1
K. Jackson
K. Jackson 11/7/2019
Replace electrical panel