HomeMy WebLinkAbout06070042 Application
City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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CONTRACTOR
INFORMATION:
NAME
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Street Address ,
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PHONE
FAX
?15-3135
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NAME
CONTACT PHONE:
APPLICANT
INFORMATION: Property Owner
(or agent)
OR
Contractor
Representative
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TYPE of WORK:
,.. RESIDENTIAL:" '
COMMERGIAL:, no - _n_ '
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
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STREET ADDRESS:
PHONE:
INSPECTION
INFORMATION:
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STREET ADDRESS (INSPECTION LOCATION):
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Zip
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State
Zip
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TIME OF INSPECTION:
LIto
DATE OF INSPECTION:
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:
Number of METERS: -j
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
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PRINT CAe ~(j / ell tfJ)r7 C/ C ~ATE 7 //;rfJ{o
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)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location) .
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/Forms/Electrical Application Apr 2006