HomeMy WebLinkAbout06040131 Application
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City of Carmel/ Clay Township () 6 () '10/3/
APPLICA TION FOR ELECTRICAL INSPECTION
NAME
PHONE
FAX
CONTRACTOR
INFORMATION: Street Address
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City
State
Zip
NAME
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CONTACT PHONE:
APPLICANT t'Y/
INFORMATION: Property Owner
(or agent)
OR
Contractor
Representative
TYPE of WORK:
RESIDENTIAL:
COMMERCIAL:
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PROPERTY OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:
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mEET ADDRESS (INSPECTION LOCATION): City
State
Zip
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mEET ADDRESS (INSPECTION LOCATION):
~
City
'/
State
Zip
INSPECTION
INFORMATION:
~~
TYPE OF IMPROV
MOVIN ICE FROM Q
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
o NO
o UPGRADE PANEL BOARD(S) [AFeI BREAKERS REQUIRED]
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
/ AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~ NEW MITER SERVICE (I.e. Fountain In pond;
Subdivision street or slgnage lighting; Installation of
new utility services for an area)
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS F M IS COMPLETE AND CCURATE.
'd~6
DATE
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
X CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
Sign ure
C,?-6"Y/
PRINT
URTHER LOCATION CLARIFICATION: (Please attach maD of InsDection location)
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FEES: $ for Commercial Inspections; $ 53.50 for Residential Inspections
S:Permlts/Forrns/Electrlcal Appllc~tlon Oct 2003