HomeMy WebLinkAbout19120055 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:
19120055
Kinder Electric 317-710-4458 mattk@kinderelectric.com
9087 Technology lane Fishers IN 46038
Matt Kinder 317-710-4458
9087 Technology lane Fishers, IN 46038
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Mike Gamble 317-710-3582
10652 West Lakeshore Dr Carmel, IN 46033
10654 West Lakeshore Dr Carmel, IN 46033
✔100 200
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2
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1
Matt Kinder 12/12/2019