HomeMy WebLinkAbout06060174 Application
City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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Street Address City State Zip
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CONTRACTOR
INFORMATION:
NAME
PROPERTY
OWNER
INFORMATION:
APPLICANT
INFORMATION: Property Owner
( or agent)
TYPE of. WORK: .." RESIDENTIAL:
STREET ADDRESS:
INSPECTION
INFORMATION:
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_ ADDRESS (INSPECI10N lOCATION):
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DATE OF INSPECTION:
CONTACT PHONE:
OR
Contractor
Representative
,
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COMMERGIAL:'
PHONE:
oty State ZIp
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City State Zip
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TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
fN EXISTING ELEcrRICAL DISTRIBUION SYSTEM
V~~W 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 CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
j(10
Number of NEW CIRCUITS:
Number of METERS:
I
,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.'
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Signature
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PRINT
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DATE
COMMENTS or FURTHER LOCATION CLARIFICATION:
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FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/Forms/Electrical Appllcatlon Apr 2006