HomeMy WebLinkAbout06070041 Application
City of Carmel! Clay Township I
APPLICATION FOR ELECTRICAL INSPECTION
NAME
PHONE
FAX
CONTRACTOR
INFORMATION:
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Oty
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State Zip
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NAME
CONTACT PHONE:
APPLICANT
INFORMATION: Property Owner
(or agent)
TYPE of WORK: ..' RESIDENTIAL: .
COMMERCIAL:
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OR
Contractor
Representative
INSPECTION
INFORMATION:
PROPERTY OWNER NAME(S):
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STREET ADORESS:
bOO L q~f1 St,
STREET AOORESS (INSPECTION LOCATION):
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PHONE:
PROPERTY
OWNER
INFORMATION:
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DATE OF INSPECT10N:
Oty State Zip
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State Zip,
41to 3i]-
TIME OF INSPECT10N:
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
o NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
" NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
Number of METERS:
I
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
I CERTIFY THAT THE INFORMATION CONTAINED
ON ~.H S FORM IS COMPLETE AND ACCURATE.
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Signature. ~zjf
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PRINT OATE
o CONNECT10N or RECONNECT10N TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
FEES: $ 100.00 for Commerciallnspectionsi $ 55.50 for Residential Inspections
S:PermltslForms/Electrlcal Application Apr 2006