HomeMy WebLinkAbout06030004 Application
City of Carmel! Clay Township .~~ c::/60 5ct{/O Y
APPLICATION FOR ELECTRICAltJ'NSPECTION '.
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NAME
PHONE
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CONTRACTOR
INFORMATION:
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Street Address
City
State
Zip
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NAME
CONTACT PHONE:
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. APPLICANT
INFORMATION:
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Property Owner
(or agent)
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Contractor
Representative
TYPE of WORK:
RESIDENTIAL:
COMMEROAL:
PROPER1Y OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:
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State
Zip'
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Zip'
STREET ADDRESS:
City
State
STREET ADDRESS (INSPECTION LOCATION):
City
INSPECTION
INFORMATION:
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DATE OF INSPECl10N:
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TIME OF INSPECl10N:
<-t 60 5
~GRADE SERVICE: From IOf) to 20 ()
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
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TYPE OF IMPROVEMENT:
o UPGRADE PANEL BOARD(S) [AFCIBREAKERS REQUIRED]
Number of NEW CIRCUITS:
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of METERS:
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE:
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. 0 NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
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COMMENTS or FURTHER LOCATION CLARIFICATION:.(Please attach maD of insoection location)
o CONNECl10Nor RECONNECl10N TO A RELOCATED
STRUCTURE
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PRINT
FEES: $ 96.25 for Commercial Inspections; $ 53.50 for Residential Inspections
S:Permlts{Forms/Electrlcal Application Oct 2003