HomeMy WebLinkAbout06060122 Application
City of Carmel! Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
CONTRACTOR
INFORMATION:
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PHONE
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. City
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State tZiP
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Street Address
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APPLICANT
INFORMATION:
NAME
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Property Owner
(or agent)
TYPE of WORK:
..-.--RESIDENTIAL:---- -
PROPERTY
OWNER
INFORMATION:
PROPERlY OWNER NAME(S):
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STREET ADDRESS:
t'
SJ..O I r:;, 1"2, .sf S+.
STREET ADDRESS (INSPECTION LOCATION):
INSPECTION
INFORMATION:
FAX
.
,
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CONTACT PHDNE:
21 "Bel<./; "0\2.0
Contractor
OR Representative 'I--
." ',. m_'. COMMERCIAL::
PHONE:
City
8cJ~ - 990 /
, ,ZIP
"I(~lO:$ .3
State
TN
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lO 033-
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City
State
DATE OF INSPECTION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~ NEW METER SERVICE (I.e. Fountain In pond;
Subdivision street or slgnage iighting; 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:
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,
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
o NO
Number of NEW CIRCUITS:
,
I
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON. THI,S FORM ISfr:PLETE AND ~CCURAr='
(71 Jo--v m SllJtL<-i
SIgnature t
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PRINT DATE I
(Please attach maD of insDection lo1atiOn)
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S:Permits/Forms/Electrical Application Apr 2006
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
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