HomeMy WebLinkAbout06080123 Application
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. City of Carmel/Clay Township ~ ~
APPLICATION FOR ELECTRICAL INSPECTION
CONTRACTOR
INFORMATION: Street Address
PHONE
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City State
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Zip
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CONTACT PHONE:
APPLICANT
INFORMATION:
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Contractor
OR Representative
TYPE of WORK: .. .... . - .....RESIDENTIAL: '
."-'" ....... .COMMEROAl:..........
PROPERTY
OWNER
INFORMATION:
PROPERlY OWNER NAME(S):
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STREET ADDRESS:
PHONE:
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City State
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Zip
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SlllEET ADDRESS (INSPEcrJON LOCATION):
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State
Zip
INSPECTION
INFORMATION:
...-----<'_.
ATE OF INSPECTlON:
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E OF INSPECTlON: PM l'1
OVING SER mOM'OVERHEAO/
TO UNDERGROUND?
pUPGRADE SERVICE: From I 000 tol5'~Jt)
'P UPGRADE PANEL BOARD(S)
~DDmON, ALTERATION, REMODEL, or REPAIR TO
. /' AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~EW METER SERVICE (i.e. Fountain in pond;
~ -Subdivision street or signage lighting; Installation of
new utility services for an area)
DYES
o NO
Number of NEW CIRCUITS:
Number of METERS:
.
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS M IS COMPLETE AND CCURATE.'
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
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o CONNECTlON or RECONNECTlON TO A RELOCATED
STRUCTURE
PRINT
DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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FEES: $ 100.00 for Commercial Inspectio
; $ 55.50 for R sidential Inspections
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S:Permll:s/Forms/Elecbical Appllcatlon Apr 2006
1,/