HomeMy WebLinkAbout06070114 Application
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i · \ City of Carmel! Clay Township
\ '.~' .. ./ APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
FAA
CONTRACTOR c:>
INFORMATION: StreetAddress
- 52-
'3( ~'l-
s-
Oty
State Zip
APPLICANT
INFORMATION: Property Owner
(or agent)
15
fAl
PROPERTY
OWNER
INFORMATION:
:is,,
Contractor ~
OR Representative
COMMEROAL: V
PHONE:
.31
Oty Slale Zip
4~zl8'
Oty State Zip
TYPE of WORK: RESIDENTIAL:
PROPERlY OWNER NAME(S):
STREET
RESS:
30 ~""'
INSPECTION
INFORMATION:
STREET AD9'2:NS&;tCATI: 1/
DATE OF INSPECfION:
TIME OF INSPECfION:
o UPGRADE SERVICE: From
to
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
~NO
DYES
TYPE OF IMPROVEMENT:
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
Number of NEW CIRCUITS:
Number of METERS: L
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
i ~NEWMETER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
I CERTIFY THAT THE INFORMATIO
ON THIS FORM IS COMPLET AND
o ROW SIGNAL, SENSOR, MONITOR (Le. Traffic Light)
o CONNECfION or RECONNECfION TO A RELOCATED
STRUCTURE'.- PRINT
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permtts/FOrmsJElectrical AppliCation Apr 2006
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