HomeMy WebLinkAbout06030113 Application
City of Carmel! Clay Township {)t 0"5 () / //3
APPLICATION FOR ELECTRICAL INSr~TIO]/
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NAME
PHONE
FAX
CONTRACTOR .<-
INFORMATION: Street Address
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S-qlo-cllccw
City
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State Zip
'2.&0\
NAME
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CONTACT PHONE:
APPLICANT
INFORMATION: Property Owner
(or agent)
3')<1- oTr
OR
Contractor
Representative '(-1
TYPE of WORK:
RESIDENTIAL:
COMMERCIAL:
PROPERTY OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:
State Zip
~~-,~o--I ':r
State ZiP
INSPECTION
INFORMATION:
~
DATE OF INSPECTION:
7.
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
WNO
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
yO ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DlSTRIBUION SYSTEM
Number of NEW CIRCUITS:
Number of METERS:
/
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Instaliation of
new utility services for an area)
,
i
,
,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COM. PLETe;zA. D ACCURATE.l
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SJ1jna~ .. .
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o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
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FEES: $ 96.25 for Commercial Inspectionsj
,
,
$ 53.50 for Residential Inspections
. . I
'S:Permits/Forms/Electrical Application Oct 2003