HomeMy WebLinkAbout06070117 Application
City of Carmell Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
Obt'J? all
NAME
PHONE FAX
3{ ~'l- 5"""
Diy State Zip
IAI
CONTACT PHONE:
.317- sz.
Contractor ~
OR Representative
COMMERGAL: V
PHONE:
31
Diy Slate Zip
46721.
Diy Slate Zip
CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION: Property Owner
(or agent)
TYPE of WORK: RESIDENTIAL:
PROPERlY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
1:Sr-
SrREEf
INSPECTION
INFORMATION:
SrREEf ADDRESS (INSPECITON LOCAll
30 ~~
TIME OF INSPECTION:
o UPGRADE SERVICE: From
to
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
~NO
DYES
TYPE OF IMPROVEMENT:
Number of NEW CIRCUITS:
Number of METERS: .:L-
o ROW SIGNAL, SENSOR, MONITOR (Le. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE '. . PRINT
(Please attach maD of insDection location)
E
FEES: $ 100.00 for Commerciallnspedionsi $ 55.50 for Residential Inspections
S:Permlts/Forms/Electrlcal Application Apr 2006