HomeMy WebLinkAbout06090065 Application
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City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
FAX
CONTRACTOR ,,/7/ CLccY",'c-
INFORMATION: St",tAdd,ess
City
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State Zip
APPLICANT
INFORMATION:
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CONTACT PHONE:
Property Owner
(or agent) c; ~ (.
OR
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Contractor tt't',4 6 ,bet-
Representative (Si7) -,?_[- '//.-f!J
TYPE of WORK:
RESIDENTIAL:
COMMERCIAL: )<
PHONE: .3
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PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
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STREET ADDRESS:
/;;t77 ~-V. /!'U
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City State Zip
;..l~AI'./. 01-10 ~vP{- r~;2 J Z-o-
City State Zip
STREET ADDRESS (INSPEmON LOCATION):
INSPECTION
INFORMATION:
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DATE OF INSPECTION:
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
~ NO
o UPGRADE PANEL BOARD(S) [AFCI BREAKERS REQUIRED]
Number of NEW CIRCUITS:
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of METERS: I
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility 'services for an area)
I
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE A ACCURATE.
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o
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ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
Signature
CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
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PRINT
DATE
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FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permtts/Forms/Electrlcal Application Apr 2006