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HomeMy WebLinkAbout19110109 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: Mister Sparky 3178748748 Kenneth.Jackson@authoritybrands.co 4040 Industrial Blvd Indianapolis IN 46254 K. Jackson 3178748748 4040 Industrial Blvd Indianapolis IN 46254 Susan Kiray 3176526762 5108 St Charles Pl Carmel IN 46033 5108 St Charles Pl Carmel IN 46033 11 22 19 0 1 K. Jackson K. Jackson 11/20/19 Replace electrical panel 19110109