HomeMy WebLinkAbout19120065 ApplicationS:\Permits\FORMS\Active Forms Binder (Copyable Form Orginals)\Applications\2017 Electrical Inspection Application.doc
Permit # _________________________
City of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
CONTRACTOR
INFORMATION:
NAME PHONE FAX
ADDRESS CITY STATE ZIP
DATE OF INSPECTION: ____/____/______TIME OF INSPECTION: 9-11 10-12 12-2 2-4
STREET ADDRESS: CITY STATE ZIP
RESIDENTIAL: ________COMMERCIAL: ________
Property Owner Contractor
(or agent) ______ OR Representative ______
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)
__________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________
FEES:$127.00 for Commercial Inspections;$70.00 for Residential Inspections
PROPERTY OWNER NAME(S): PHONE:
STREET ADDRESS (INSPECTION LOCATION): CITY STATE ZIP
INSPECTION
INFORMATION:
Frye Electric Inc 317-271-1099 317-371-1499
8403 E US HWY 36 Su B Avon IN 46123
Gregory L Wells 317-339-3183
X
X
Main Street on The Monon Apartments 317-844-3245
60 Knoll Court Carmel IN 46032
309,311,313,315,317 3rd Ave NW Carmel IN 46032
12 19 2019
_______
X
X
5
REPLACE THE OLS 5 GANG METER MODULE WITH A NEW UNIT COMPLETE
FORM IS COMPLETE AND ACCURATE
SIGNATURE
Gregory L Wells 12-12-2019
19120065