HomeMy WebLinkAbout06050047 Application
City of Carmel! Clay Township '1/f/'r(j ?~ r "0
APPLICATION FOR ELECTRICAL INSPECTION
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(J n FAX
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CONTRACTOR
INFORMATION:
NAME
APPUCANT
INFORMATION:
TYPE of WORK:
RESIDENTIAL:
PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
STREET ADDRESS (INSPECTION LOCATION):
INSPECTION
INFORMATION:
e;
DATE OF INSPECITON: J-g~
TYP~F IMPROVEMENT:
" UPGRADE SERVICE: From/f)()I/rlPto "ttJO A-I'l P
f UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECITON or RECONNECITON TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION ~RIFICATION:
.~. .... ?-......
State
Zip
rJl1
/3 I
LLE
('j
Contractor
OR Representative
COMMERCIAL: '" .
City State Zip
C
City State Zip
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MOVING SERVICE FR
TO UNDERGROUND?
DYES
)KJ NO
Number of NEW CIRCUITS:
Number of METERS: --1--
I CERTIFY THAT THE INFORMATION CONTAINED
ON yM ~MPLETE AND ACCURATE.
Signature I
t: D R HOOn..) S- -5 - 0&
PRINT DATE
FEES: $ 100.00 for Commerciallnspecti ns; $ 55.50 for esidentiallnspections
S:Permlts/Forms/Electrical Application Apr 2006 '----r--~--/