HomeMy WebLinkAbout20010164 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:
20010164
James H Drew 3178763739
8701 Zionsville Rd.
Indianapolis IN 46268
City of Carmel
3178763739
46268
City of Carmel
1 Civic Square
Carmel IN 46032
4164 E 96th St
46240
✔
✔
1
1
North side of roundabout at intersection of 96th & Delegates
Bradley Pease
Digitally signed by Bradley Pease
DN: cn=Bradley Pease, o=City of Carmel,
ou, email=bpease@carmel.in.gov, c=US
Date: 2020.01.28 15:52:55 -05'00'