HomeMy WebLinkAbout06090042 Application
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City of Carmel! Clay Township .
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
FAX
CONTRACTOR
INFORMATION:
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City
State
,
Zip
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,
NAME
CONTACT PHONE:
APPLICANT
INFORMATION:
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Property Owner
(or agent)
OR
Contractor
Representative
TYPE of WORK:
,'" RESIDENTIAL:-
COMMERCIAL:
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INSPECTION
INFORMATION:
PHONE:
PROPERTY
OWNER
INFORMATION:
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State ZIp
TYPE OF IMPROVEMENT:
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TIME OF INSPECTION: I
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MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? I
o UPGRADE SERVICE: From
to
DYES
g--- NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
Number of METERS: /
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~EW METER SERVICE (Le. Fountain in pond;
Subdivision street or signage lighting; Instaliation of
new utility services for an area)
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
o ROW SIGNAL, SENSOR, MONITOR (i.e, Traffic Light)
Signature
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
DATE '
PRINT
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
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S:PermltsjForms/Electrlcal Application Apr 2006 I