HomeMy WebLinkAbout06060222 Application
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City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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APPLICANT
INFORMATION:
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PHONE FAX
City State Zip
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CONTACT PHONE:
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Contractor
OR Representative
COMMERCIAL: X-
PHONE:
City State Zlpl
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City State Zip
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TIME OF INSPECTION:
,
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
NAME
CONTRACTOR ,Lhur C. P,,-rr
INFORMATION: Street Address
Property Owner
(or agent)
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TYPE of WORK:
RESIDENTIAL:
PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
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STREET ADDRESS:
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STREET ADDRESS (INSPEcrION LOCATION):
INSPECTION
INFORMATION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
DYES
o NO
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of NEW CIRCUITS:
Number of METERS:
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
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,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AN CCURATE!
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o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
.)( CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
Signature
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PRINT
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~ DATE ~
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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$ 100.00 for Conimercial Inspections; $ 55.50 for Residential Inspections
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S:Permits/Forms/Electrca Application Apr 2006
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