HomeMy WebLinkAbout06060175 Application
City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
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CONTRACTOR
INFORMATION:
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Street Address
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City
State Zip
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APPLICANT
INFORMATION:. Property Owner
(or agent)
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CONTACT PHONE:
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NAME
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Contractor
Representative
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PROPERTY
OWNER
IN FORMATION:
PROPERTY OWNER NAME(S):
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STREET ADDRESS: V
PHONE:
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State
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City
State
INSPECTION tio'7 '!1Jf;./tve
INFORMATION:
DATE OF INSPEcnON:
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TIME OF INSPEcnON:
TYPE OF IMPROVEMENT:
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MOVING SERVICE FROM OVERHEAD
TO UNDERGROUIIIDVJ? '. i
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Number of NEW CIRCUITS: I
Number of METERS: ~ I
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I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS CO~E AND ACCURATE,;
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Signature I
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STRUCTURE PRINT DATE I
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection 10JtiOn)
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o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
czy-NEW METER SERVICE (Le, 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 CONNEcnON or RECONNEcnON TO A RELOCATED
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
. 5:Permlts/Forms/Electrical Application Apr 2006