HomeMy WebLinkAbout06070112 Application
City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
"O//~
NAME
PHONE FAX
~ 52.- 31
Oly Stale Zip
IAI
.3/7 - 5Z 8
Contractor ~
OR Representative
COMMEROAL: V
PHONE:
31
Oly Stale Zip
4fpzt.
Oly Stale Zip
CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION: Property Owner
(or agent)
TYPE of WORK: RESIDENTIAL:
PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
Au;
'is,....
STREET
30
~'5
STREET ADORESS (INSPECTION LOCATION):
INSPECTION TH $" T
INFORMATION:
DATE OF INSPECTION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
." fSlf'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 (Le. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCfURE'"
TIME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
~NO
DYES
Number of NEW CIRCUrrS:
Number of METERS: L
I CERTIFY THAT THE INFORMATION CONTAIN~D
ON THIS FORM IS COMP ETE AN AC URATE..
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A.'~ ttIlfelleJ
PRINT
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FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:PermltsjForms/Electrical Application Apr 2006