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FAX NO,
p, 02
CONTRACTOR
INFORMAnON:
APPLICANT
INFORMAnON:
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
INSPECTION
INFORMATION:
City of Carmel! Clay TownshiPv1$17)/
APPLICATION FOR ELECTRICAL INSPECTION
tJO 3
NAME
PHONE
FAX
Signal Construction, Inc.
streelMd,.,.
5639 West U.S. 40
(317)894-0120
Cly
Greenfield
stole lip
IN 46140
(317)894-2121
NAME
AM' Engineering on behalf of the Ci ty of CarnEl
CO~ACTPHONE: MF: (317) 202-0864
CarnEl: (317) 571-2441
Property Owner
(or agent)
Contractor
Representative
x
OR
,. RESIDENTIAL: ' Traffic' Sigro;.l X" COMMERCIAl;:
PII0PER'IY OWNER NAME(S):
City of Carnel
STRfET ADDRESS: ZIp
One Civic Square 46C32
STREE'r ADDRESS (INSPECTlON LOCA'IlON): ZIp
136C2 Gray Road
DATE OF INSPECTION: TIME..QEINSaECl=! .
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
o YES
o NO
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
o NEW MITER SERVICE (I.e. fountain in pond;
Subdivision street or slgnage lighting; Installation of
new utfllty services for an area)
Number of NEW CIRCUm:
Number of METERS: 1
1 CERTIFY lHAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACOJRATE.
.:5 oS {<'EN<G 6e
S1gnilwre
(Xl ROW SIGNAL, SENSOR, MONITOR (I.e. Traffic Ught)
o CONNEcnON or RECONNECTlON TO A RELOCATED
STRUCTURE
20Z.-080Y
PIU~
DA'"
,
,
COMMENTS or FURTHER LOCATION CLARIfiCATION: (Please attach maD of Insoeetlon location) "
FEES: $ 100.00 for Commerciallnspectionsi $ 55.50 for Residential Inspections
S:PtrmI_rmJ/EI_1 Appl<atlan ApI 2006
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