HomeMy WebLinkAbout06080041 Application
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City of Carmel/Clay Township ft/M. '[ 0-
APPLICATION FOR ELECTRICAL INSPECTIO~
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PHONE FAX
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0355
CONTACT PHONE:
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Contractor A
Representative
COMMERGIA~:
PHONE:
NAME
CONTRACTOR ,/
INFORMATION: StreelAddress
NAME
APPLICANT
INFORMATION:
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Property Owner
(or agent)
OR
TYPE of WORK:
... RESIDENTIAL::
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PROPERlY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
STREET ADDRESS:
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State
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AMEL
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STREET ADDRESS (INSPEC110N LOCATION):
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Slate
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INSPECTION
INFORMATION:
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TIME OF INSPECTION:
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o UPGRADE SERVICE: From L{ oc) to ro 0rJ '-"'~ jJ
o UPGRADE PANEL BOARD(S) I JA
'lit( ADDmON, ALTERATION, REMODEL, or REPAIR TO ~
.'" AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? . !
TYPE OF IMPROVEMENT:
DYES
C;(. NO
o NEW METER SERVICE (I.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
I CERTIFY THAT THE INFORMATION CONTAINED
n;J:lMn::Z;;TE.
Signature . ;BY;2--0)'07'
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PRINT DATE
o ROW SIGNAL, SENSOR, MONITOR (Le. 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 Commerciallnspectionsi $
'6r Residential Inspections
S:Permlts/Forms/ElectJical Application Apr 2006